Preview
A.G.- F'.W.
NCP Name: JAVIER PUGA CENTRAL
CP Name: CINDY ANN MARQUEZ
OAG NUIIlber: 00095l9l59
CAUSE NUMBER 2?:>\ '33) 1%-0a
IN THE INTEREST OF
§ IN THE '2 ~ I DJSTRJC1' COURT
CASANDRA MARIE PUGA § OF
A MINOR CHILD § TARRANT COUNTY, TEXAS
~ERIN SUIT AFFECTING THE PARENT-CHI
h.. 0."""
D RELATIONSHIP
().,{d/.Q.y 5
o • o<,.O b~ .
•U.u/l
On th~ ~day of (Y\,e;t.).1 • 20.QJ:_ th · · · v- . v ' .. ~
I ~V f I
The OFFICE OF THE ATIORNEY GENERAL appeared by an ASSISTANT ATI'ORNEY GENERAL.
CINDY ANN MARQUEZ, mother of the child, social security number 454-57-2778, driver license number
19998397, hereinafter referred to as Obligee,
U appeared in person {am! b! a((Orifey-- pn) .s.e._ l;
tJ agreed to the entry of these orders as evidenced by her signature;
U although duly notified, did not appear.
JAVIER PUGA. ALLEGED FATHER of the child, social security uwnber hl j - j! 0-) J.'. 'fuiver license
number. f0 D)"~ , hereinafter referred to as Obligor,
lY appeared in person (and ll) atton•e: ,OCD S~t l;
L.( agreed to the entry of these orders as evidenced by his signature;
L1 although duly not1fied, did not appear.
The Court fmds that it has julisdiction of the partie• and the subJect matter of this suit, and that the following
orders are in the best interest oftm: child.
A record of the proceedings was:
[3""' waived by the parties with the consent of the court.
U made by audio rerording.
f 7467 3PAGE0042
PAW:...L.IIPJ1
CHILDREN
The following child residing in TARRANT County, 1'X is the subject of this suit:
Name Su: DOD SSN
CASANDRA MARIE PUGA F 212100 631·70·1849
The Court FINDS thatJAVJER PUGA, the ALLEGED FA711ER of the child, bas a duty of support.
CONSERVATORS
The Court APPOINTS CINDY ANN MARQUEZ and JA VJER PUGA Joint Managing Conservators of the child.
Each parent appointed as a conservator of the cbild bas at all tinres the following rights, privileges, duties, and
powers of a plll"lllll:
a. of access to medical, dental, psychological and educatioual r.cords of the child;
b. to consult with any physician, dentist, or psychologist of the child;
c. to consult with school officials conceming the child's welfare and educational status, including school
activities:
d. to attend school acti,ities;
e. to be designated on any records as a person to be notified m cas~ of an emergency;
f. to manage the estate of the child to the extent the estate bas been created by the parent or the parent's
family:
g. to receive infonnation from the other parent conceming the health, education, and welfare of the child:
h. to confer with the other parem before making a decision conceming the health, education, and \\elfare of
the cbild;
i. to consent to medical, dental, and surgical treal>uent durwg an emergency involving an immediate danger
to the health and safety of the child;
The Court designates CINDY ANN MARQUEZ as the conservator with the exclusive right to detemriue the
primary residence of the cbild. The Court orders that CINDY ANN MARQUEZ
LJ maintain the child's primary residence in TAiiRANI' county or any contiguous county.
[x) may dctennine the child's primary residence without regard to geographic location.
The conservator designated with the primary physical residence of the child bas the following exclusive rights,
privileges. duties, and powers of a parent;
a. the right to the sen'ices and earnings of the child;
b. the right to COil!Cllt to marriage, to enlistment in the armed forces of the United States, \0 medicW, dental,
and surgical treatment involving invasive procedures, and to psychiatric and psychological treatment;
F7467 3PAGE0043
c. the power to represent the child in legal action and to make other decisions of substantial legal
signiti1:ance concerning the cl ::d including the right to .:stablish the primary residence of the child; and,
d except when a guardian of the child's estate or a guardian or attorney ad litem has been appointed for the
child, the power as an agent of the child to act in relation to the child's estate if the child's action is
required by a state, the United States, or a foreign government.
CINDY ANN MARQUEZ has the cx.clusive right and power to receive and give receipt for periodic payments for
the suppoll of the child and to hold or disburse these funds for the benefit of the child.
During pmod.s of possession of the child each parc:nt appointed as a conservator of the child r~'lains the following
rights, privileges, chuies, w1d powers of a parent, subject to any limitation imposed by court order in allowing a£cess to
the child:
a. the right to physical possession and to direct the moral and religious training of the child;
b. the dut) of care, control, protection, and reasonable discipline of the child;
c. the duty to support the cluld. including providing the child with clothing, food, shelter, and medical and
dental care not imolving an invasive procedure:
d. the right to consent for the child to medical and dental care not involving an invasive procedur,·: and,
e. the right to consent to medical, dental and surgical treaunent during an emergency involving an
immediate dwtger to the health and safety of the child.
VISITATION
The Court ORDERS, pursuant to Texas Family Code Chap.:cr 153, JAVIER l'UGA and C/N/JY ANN MARQUEZ
to rl:\iew and follow the visttation schedule that is attached to this order Wid incorpomted by reference.
F7467 3PAGE0044
STA.'NDARD POSSESSION ORDER
DEFINmONS
Child The tmn "child" refers to the cllild or children of the parties who are the sub~ of this &ui1 and shall
illdudo the plurll fonn whel1cvcr 'lJlpropriato to the ocotcxt.
School 'Ibtl tenn "school" rofers to the 1--tihwy or secoodary echool iD. wbidl the child is llllrOllod, or, if the child
is not mrollcd in a primary or~ sr.booJ, the public sciMd di.mieginnina at (CHOOSE ONE)
..X.. 6:00 p.!!l. oo the liM, third and fifth Friday of each momh
the time the child's sdlool ;is rcg.U.Uly ctiSlllliSCd on the first, third aDd fifth Friday of each momh
and ending at (CHOOSE ONE) .
X 6:00 p.m, on the follov.~ Sunday.
the time school resumes on the following MCIIday.
:EM.oc:pt as olhorwise explicitly provided he!"ein, if a weeketld period of possession of Ob!tgor coincides •lith a
=
scllool holiday during the regular scllool tctru, or with a fedml, sWe, or local boliday dwing the rnontha
in which school is not iD. sessioo, the \\·cckbl possessioo shall begin at the regular time Thunday, instead of
Friday, for a f'riday buliday llldlor shall ead at the regW.ar time MODday, iD.slead of Sunday, for a Mooday
holiday, as applicable.
Wedllesdayl. Vbltgor shall ba\-e the right to possession of the child on Wednesdays of each week during the
regulu ~~~:boo! tenn begi.Dni.na at (CHOOSl! ONE)
.X. 6:00p.m. llld en4i1lg at 8j()() p.m.
the time the child's sdlool is regularly dismi•sed llld eodiDg at 8:00p.m.
the time the child'elicbool.is regularly diam;•scd llld eodiiJ8 at the time the child's adlool
resumes.
Sprirl& VIIClliou. Obligor aball haw~ of the child in evC111118llbered yean bcglnnhJill (CHOOSE
ONE)
~ 6:00p.m. 011 the day the child i.s disminec! li'cm school for the sdlool's spriDg vaCIIioo
tho time IUld 011 the day thb dlild ia ctismjswt fn:rn scbDol for tho sdloc»'s sprina vacati.OII
IUld eodilla II (CHOOSE ONB)
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f 7 46 7 ~PAGE 00 ·l5
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X 6·00 p.m. on the day befmic school RSIIIIIC>O after that vacation.
the time and on the day scboolrcswncs after !he school's 4pring vac.ali011.
Obltgfl shall have pouessim for the same period tn odd-IWI!Ibemi years.
St1.......,. Vawioa.If Obligor gives Obligee writhm lllltice by Aprill of each year specifying 111 exlellded
period or paiods of SUiri:IW posscssitm, ~llgor lballllaw ponaoica of1hc child for thirty days beginning 110
ca.dicr thar! !he day aftea' ~ child's s;hool is dismissed for the IIUIIIIIIer Vloelltionl!ld encl.itlj! 110 later than aevCD
days prior to !dlool zesumin& at the em!. of the IWDillCr vacllioa, to be ma:r.ised in no more llw1 two acpara!o
periods of at least smu C(I!UeCUtjve days w:b
If Obligor docs not gi~11 Obligee writtm DOiicc by April! of each year ~ an exttnded period or periods
of SWIIIIIer JMX!seWOO. Obligor sba1l bave ~JoSSession of the dlild for thirty COII5tiC:IIIivc days beginning at6:00
p.m. 011 July I and ClldiD,g at 6:00 p.m. on July 31.
FW1bemlore, if Ob/lgn gives Obligor wriitm notice by April IS of cach year, Obligee sba1l ba\'C pos.smion of
the cbild on any one \\ukend be$inning 816:00 p.m Friday and aulnl8 a16:00 p m. oo the following Sunday
durius any 011e exteaded period of SUJI\Il\U·poMCSsion by Obligor, provickd that Oblige• pic:lu! up the clilld from
Obligor 811d retlltll81hc child to that same pW:c.
Fur!bemlore, if Obllgn gives Obligor written DOiicc by April 15 of each year or gi~ Obligor 14 days writtCD
notice 011 or after April 16 of eadl year, Obllgtt may dctigllate ooc \\'CCkmd begiimi.ng no earlier than the day
after the child's school is dismissed for the~ Vlllllion and ending rw later that seven days prior to school
mumi.na at the Clld of tho sun.mcr vacatioh, chuing whidlan otherwise scbedulcl .:mend period ofposses!ioo
by Obltgor will not tab pW:c, provided that the weekeod so dMign•ted docs not interfere with Obligors period
or periods of ext.caded SlllliiiW ~sion or with Father's Pay if Ob!Jgor is the fathN" of the child.
PA.RE!'"TS WHO RESIDE. OVER 100 MILES APART
Except as otherwise elqllicitly provided. if Obltgor resid8s more than 100 miles from the residence of the
child, the parents shall have the fi&hta to JX'8.'CS.5iOII of the child as foUows:
Wtelwl.ds Obhgor shall bave the right topunessim ufthe child (CHOOSE ONE}
oa \\~ beginnina at (CHOOSE ONE)
6,00 p.m em the tint, thiid and fifth Friday of eath IIIOIIIh
the time the child'a &chool il fC8\I)arly dill!l!nocl co the lint, tbird and 6tlh ftulay of
each lllOil1h
lllld eoding at (CiiOOSE ONE)
6:00 p,m. ClOthe 6illowiDa Swday.
the time lllbool ~ 011 tho followill& Mooclay•
.- "(U~elewl ycm.
lbanksaivial- Ob/tgor shall have possession of the chila ... .ldd-IIUIIIbered years beginning at 6:00p.m. on the
day tbe cl!i1d ia dismissed rom school be~ ' ThanksgiviDg and ending at 6:00 p .111. on tho followi.o& Sunday, and
Obltgu shall have posse$Sioo for the same period in even-numbered years.
I
Child'• Birthday. The parent uotothen\'ise;emit.led under !his order to prcsc:nt possession ofa child on the
cllild's birlhday lhall have possessi.oo oftbe child beginning at 6:00p.m. and ending at 8:00p.m. on that day,
provided that said parcat piclcs up the dli1d; from tbc residence of tilt OOO>CIValor entilled to possession and
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returns tho child to that same place.
Father's Day. Tho falher ahalJ ba\'e posseisjon oflho child beginning at 6:00p.m. on the Friday proceding
Fatlw's Day and ending at 6:00p.m. 011 Father's Day, provided that, if he is 110t otherwise entitled under thia
order to pRSCIIt possession of the child, hapicb up the c:hild fr001 the residence of the conservatorealitled to
possessioo and returns tbe clilld to that same place.
Mother'• Day. The mochc: shall have ~iOil of the dlild bqj•••ing at 6:00p.m. onlho l'riday ptceeding
Mocher's Day and ending at 6:00 p.m. 111 ~olher's Day, provided that, if she is DDI otholwiso Clllitled under tbis
ordrt to pmcnt poucaioa oftbe child, siJ p.iob up tbeabildfrom the residaloe oflhe coasorwtor anitled to
poswsioollld Rtllrlla lhe child lo the same place.
POOR QUALITY ORIGINAL DOCUM£!T
F7467 3PAG£0048
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GENERiu- TERMS AND CONDITIONS
;
ExQePt as Clherwisc ex;licitly provi«~ tenus IUld IXIlditi01111 of possession ofth~ child that apply
irrespccrtivcJ oflhB dil1aDGC bclwccll 1M resi4enco of Obligor and 1M priroary rosidl:llco of 1M child arc as
fullows: ,
'1bc provisioas forposacasi011 oftbc child dJ/rin& ~ Thanksaivin& SpriDg VacaliOD, Summer VawiDD,
the dlild's biitbday, Falhilf's day,llld Motii¥D ~- llllpii1IXIc auy r4lfli<:liDg wcckCild or W~day periods of
~w. .
Wriltta llOCicc sball be !kancd to baw ~timely aivra iflllllCivedor posllllarbd bcfo!1l or at the time that
notice is due.
Obligee shall~ the child to Ob/igo~ at the beginniDg of each penod of Obligors poesessi011 at Oblig~e's
milbce. '
If Obligor ek;;ts to begin a pcriljd
ofpollseasim at the time tbe child's school is regularly dismissed,
Obllgte dial! swrtlldcr the child to Obllgot at the hegn)nlog of eacll such period ofpossessiOD at lho scliool in
which the child i! eorollcd.
Obligor shall (CHOOSE ONE)
S\lri'Cilder the child to Obltgee at lho eod of each period ofpoasession at the residence of Obligor.
.X. return the child to thll rosi~co of Obligee at the end oflhe petiod ofpossessim, except that if
Obligors oounty of d0111iclle remains lhe same after the =dillon of this order and if Obligee's
oounty of domicile shoold i:haoso, effective oo the dau: of the c:hango of domicile by Obligee,
Obligor shall surn.nder th.' chi1d to
Oblige~ at 1ho end of each period of possessioo at 1ho
If~ltgor elel:ts to eod a period ofposse.5sionat the time lhe child's
11l5iclence of Obligor.
scliool resumes, Obligor &ba1l ~ the c:hild to Obligee at the school in v.bich the child is
elll'Olled
Bach CCUSCI"Uot &ba1l return with the chil~ tho )lOI'&(IIWl effed.s that the child brought at th.c btginnins oflho
period •Jf possession.
Eilbcr parart may designate any ~ ldult to pick up and relllrn !be cbild, as appli ..able. A parent or a
designated ~X~Dpetcnt adult sball be JUCSetd when the child is picked up or returned.
A pareat shall give DO!ice to tb.J peroon in posses!ion of the child on each ocwion lhat the panmt will be unable
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to ex«Cise that pa.tmt's riabt of posse$sioll for any specified period.
~ failure of a parent to give notioo
of an inability to exerr.ise posscssocy rigbU may be COII.Iidmdas a fKtorin a modifir.aliou ot'tbosa JXISSCSSO!)'
fi8bls.
If a C()DSOI'VIIor'a tinlll of posetuion of a cllild eods at~ timll !lcl!of..! rt.$liiiiCSIIId fur any l?.asoll tbll child is not
cooJr.'ltor in pouession of!be child shall imlr.e>Jiately ldfY tbc school
or -..ill llDI be 11llll!'ned to sdlool, the
and the uhllr CXliiiCI'\'IItor that lhe child \viii DOt boor 1w liOl been Rlwt1td. to school.
POOR OUAUlY ORIGINAL OOCUM~T
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F7 467 3PAGE~049
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CURRENT CHJLD SUPPORT
The Court ORDERS JAVIER PUGA to pay CINDY ANN MARQUEZ current child support of S 0] &'0 ()
each month beginning the I ~i day of 9/J!'N ,'J.D Dd. ,
payable on or before that date and on or
before the same day of each month thereafter while any child is less than 18 years of age or while any child is fully
enrolled in an accredited school in a program leading toward a high school diploma or enrolled in courses for joint high
school and junior college credit pursuant to Section 130.008, Education Code, whichever occurs lasl, or until every child
is othel\vise emancipated.
The Court ORDERS JA Y1ER PUGA to pay all child support through the registry prescribed in this decree, and
any direct payments by him or any expeoditures incurred during his periods of possession sba1l be deemed in addition to
and not in lieu of the child support ordered herein.
The Court ORDERS that any pa)mcnts received for the benefit of the child from the Social Security
Administration, Veteran's Admir~siration or other similar beoefits, except for income withholding as ordered herein, shall
oot be credited against JAV/h'R PUGA's obligation.
The Court further ORDERS that the child support provisions of this order shall be an obligation of the estate of
JAVIER PUGA, and shall not terminate on his death.
Other: ---------------------------------------------------------------
f 7467 3PA&E0050
PAu&l OP J1
FINDINGS ON HEALTH INSURANCE AVAll..ABILITY
The Court FINDS:
(Check only one of the following)
_/_ 1. (a) Health insurance is available or is in effect for the child(ren) through JA. VIER PUGA.'s employment
or membership in n union, trade assoeiation, or other o·;ganization at a tf'lsonable cost to JAVIER PUGA,
and (b) JAVIER PUGA should be ordered to provide sucb insurance.
__2. (a) Health insurance is not available for the cbild(ren) thruugh JA. VIER PUGA 's employment; (b) health
insurance is available for the child(ren) at a reasonable cost througil CINDY ANN MARQUEZ's
employment or membership in a union, trad~ ~ssociation, or other organization; (c) CINDY ANN
MARQIIEZ should be ordered to provide such iru;urance; and (d) JAVIER PUGA should be ordered to
pay additional child support for the actual cost of such health insurance.
__3. (a) Health insurance is not available for the child(ren) at a reasonable cost through JAVIER PlfGA 's nor
CINDY ANN MARQUEZ's emplo}ment or membership in a union, trade association, or other
organization, (b) health insurance is available to JAVIER PUGA from anotlv'r source at a reasonable cost;
and (c) JAVIER PUGA should be ordered to provide such insurance.
__4. (a) Neither parent has access to jlrivate health insurance at a reasonable r.ost; (b) CINDY ANN
.IMRQUEZ should be ordered to apply immediately or maintain on behalf of the child(ren) for
participation in a medical assistance progran· ,Msuant to Chapter 32, Human Resources Code, or the
state child health plan pursuant to Chapter 6~. Health and Safety Code; and (c) JAVIER PUGA should be
ordered to pay additional child support fo. the actual cost of participation of the cbild(ren) in such
progran1.
__5. (a) Hc.1lth Coverage is not available for the child under subdivisions I through 4 above, and (b) JAVIER
l'VGA should be ordered to pay CINDY ANN MARQUEZ a reasonable amount each month as medical
support for the child.
__6. Good cause exists to deviate from the statutory priorities in or~. ring health msurancc.
'!be Court further finds that the following orders regaoding bcalth insurance are in the best inter~st of the
child(reo).
F746 73PAGE0051
PAOli lb. or J1
HEALTH INSl'RANCE TO BE PROVIDED BY OBLIGOR
As additiocal child support, the Court ORDERS JAVIER PUGA to obtain, within 15 llays after entry of this
o"lder, hl'3!tb insU!liJICC for ~h child subject of this suit that covers basic bcalth care services, incl•uliJI!l usual physician
scnices, office visits, hospitalization, labo!'lltory, x-ray, and emergen.:y services.
The Court ORDERS JAVIER PU&A to maintain such health ins= in full force and effect on each child
subje~.'t of this suit as long as child suppo.'t is payable fo; tilat child.
The Court ORDERS JAVIER PUGA :o COil\'ert any
group insurance to individual covef38C for e11th cl-i!(l within 15 days oftennination of his employment or othe;
disqualification of him from the group insurance. Th•: Court ORDERS JAVIER l'llGA to exercise any conversion
llptiDIIS in such a manner !hat the resultJng insurance equals or e.xceeds that inunediately before the conversion.
The Court ORDERS JAVIER PUGA to furnis:1 CINDY ANN MARQUEZ and the OFFICE OF lliE ATIORNEY
GENERAL CHILD SUPPORT UNIT 0402E n true and correct copy oft he health insurance policy or certification :md a
schedule of benefits within 30 days oftbe signing of this onler. The Cou t ORDERS JAVII£R PUGA to fumi&h CINDY
ANN MARQUEZ the insurance car~s and any other fonns necessary fr •se of the insurance within 30 daye ·~f the signu~g
of this ord.r. The Court ORDERS ./A J7ER PUGA to pro•·idc, within th>.:c days of receipt by him, tC' r/NDY Al\"N
MARQUEZ any insurance checks, olher payment:.. or C."Planalions ~f benefits relating to any medica .penses for the
child that CINDY ,iNN MARQUEZ paid or mcurred.
Pursuant to Te'<.iS lnsur:mce Code article 3.96-3. the Court ORDERS that if.JAVIER !'UGA is eligible f.,..r
!kpcndant bealth cover~ge. but fails to apply to obtain coverage for the child, the insurer shall enroll the cllild on
application of CINDY ANN MARQUEZ or others us authoriud by law.
In =rdance with Texas J.r..surancc Code articles 3.5!-13 and 3.96-7, the Court ORDERS that CINDY ANN
MARQUEZ, at her option, or ot!:m as authorized by law, may file claims for health-care expenses dirrctly \\ith the
insurance· 1rrier. and receive pa)ments from the insurer, \\ith and from whom coverage is provided f0r the benefit ofth.:
child. Further, for the sole purpos• of article 3.51-13 of the Texas Insumncc Code, the party who is not carrymg the
health insurance policy is designated the managmg consen ator or possessory conservator of the child.
UNREII\IUUn5ED HEALTH CARE EXPENSES
ibc Court. pursuant to Texas Family Code§ 15·1.183(c), allocates the reasonable and necessary health .:are
~.xpcmes of the child that arc not reunbursed by health insumncc a5 iJIIO\\S:
Tne Court ORDERS CINDY A.VN MARQUEZ to pay ..1Q....% and ORDERS JAVIER l'UGA to pay .J.Q_% of the
unreimburscd health care expenses if. at the time the expenses arc incurred, the party ordered to provi1e health insaran.:e
for the child is providing healtl1 inswanoe as orde.red.
WARNING
A parent ordered to provide bulth insurance who fails to do so is liable for 100% of nett.·ssary medical
apensa of the cbild, without rqard to whether the expenses would have been paid if be·' !: :..surance hal' been
p:ovided. and the cost of health insw'allte premlu111.1 or cuntribulions, if any, paid on l>ehalf oftbe child.
The Court ORDERS the~- who incurs a health care expense on behalf of the child to submit to the .!her party
-s within 30 day£ after
all forms, receipts, bills, and staterneats reflecting the uninsured portion of the health care ex; ·;
be or she receives them. The Coort ORDEI\S the 11011-incurring party to pay his or her percent'lgll of the uninsured
portion of the health care expemcs ci%bet by paying the health care provider directly or by reimbursing the incurrirg party
for any advance pa~ment o\·er and ;abo\-e the incurring party's percentage of the uninsured portion of the health care
cxpmscs Y.ithin 30 days after the noa-iDc ·:ring party reo:ives the forms, r=ipts, bills, or staleiMll!!.
These provisions apply to ail unreimbursed health we expenses of any child subject of ulis suit that arc iru:urred
v.hile child IIIPJlOrt is pa)'ablc for !hal c:hiid.
f 7 467 3PAGE0052
CHILD SUPPORT GUIDELINE FINDINGS
The Court FINDS, pursuant to TCXliS Family Cede§ 154.130:
(I) the monthly net resources of the OBLIGOR per mooth are S \ .3 ~;) •O\
(2) the monthly net resources of the OBLIGEE per mooth areS N fr ;
(3) the percentage applied to the OBLIGOR'S net resources for rhild suppott by the actual order renderetl by
the Court is dl> %;
(4) the am~\lllt of child support if the pera:lllage gui«Wincs W'C applied to the first $6,000 of the OBLIGOR'S
net res Jurces is $ p /{..:;: l)()
:
(5) if applicable. the specific reasons that the amount of child support per month ordered by the coutt vanes
from the amount stated in Subdivision (4) arc:
u the Court ordered OBLIGOR to pay an additional s.____ per month current child support
bet:ause OBLIGEE is ordered to rrovide health insurance; and
u the Court subtracted benefits of$ _ __ p e r - - - - paid to or for the child as a
result of the OBLIGOR'S disability: and
u
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(6) if applicable. the OBLIGOR is obligated to &upport chtl:ircn in more than one household, and:
(A) the number of children before the court is _I_
(B) the number of children not before the court restding m the same household with the OBi..IGOR is
(};and
(C) the number of children not before the court fur whom the OBLIGOR is obligated b~ a court order
to l>'lY suppol't, \vithout regard to whether the OBLIGOR is delinquent in child support payments,
and who are not counted under Paragraph (A) or (B) is .1:1_.
f 7 467 3PAGE00G3
P.uaJl.orD
RETROACTIVE CHILD SUPPORT
The Court FINDS that retroactive child support should be ordered, in the amount ofS 'f>J.)\ , li b as
of ffi~\Jo , 0@~ , and that the retroactive child support is assigulld to the OFFICE OF THE
ATTORNEY GENeRAL pursuant to Texas Family Code Chapter 231.
The Court GRANTS JUDGMENT a&ainstJAVIER PUGA and in favor of the OFFICE OF THE ATTORNEY
GENERAL in the amount of S q; d- '6 • () u with interest a1 the rate provided by law, for collection and
distribution according to law.
The Court ORDERS JAVIER PUGA, the Obligor, to pay said child support judgment \l)"fJAYill!"
aud by paying
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S 49· 0 U
on or lii:Tore the _nay of
~;ach month beginning the~ day of ;:i fM:,Q , Ch\))J., payable on or
IK.fore that date and oo orb~fore the same day of each month ther ~until the arrearage is paid in full, or oa the
termination of current support for any child the subject of this suit.
If JAVIER PVGA has not paid the judgment in full by the date his current child support obligation ends, the Court
ORDERS him to pay the remainder of said judgment by paying$_ 3a, $'", 6,) each month on or before th~
same day of each month until the arrearage is paid in full. TI1e withholding order authorized herein shall include such
pa)ments. but nothing herein shall prohibit the usc of other collection methods authorized by law.
F7 467 3PAGE00~4
ORDER IN SUIT Arnc:tiNO 1111 P,uwaoCIIllD IWATIONIIIII'
INCOME WITHHOLDING
The Court ORDERS, pursuant to Texas Family Code Chapter 158, any employer of JAVIER PVGA, current or
subst:quent, to withhold income from the disposable earnings of JAVIER PUGA for the child's support as set out in the
ORDERINOTICF TO WITHHOLD INCOME FOR CIDLD SUPPORT entered herein. Any income withheld from
JAVIER PUGA's disposable earnings tor child support and paid according to this order shall be credited against his child
support obligation, but shall not discharge any of his child support obligation that exceeds the amount so credited.
The Court ORDERS the Clerk of the Court, upon request, tc cause a certified copy of the ORDER/NOTICE TO
WITHHOLD INCOME FOR CHILD SUPPORT, with a copy ofTexas Family Code Chapter !58 attached, to be
deliv.:red tc JAVIER PUGA's employer.
The Court ORDERS JAVIER PUGA to provide any subsequent employer with a copy of the ORDER/NOTICE
TO WITHHOLD INCOME FOR CHILD SUPPORT entered herein.
PA\"MENT OF SUPPORT AND COSTS
The Court ORDERS JAVIER PUGA to pay all support t" the registry of the court:
Texas Child Support Disb•uscmcnt Unit
P0 Box 659791
San Antonio, TX 78265·979 J
for distribution according tl'law. All pa)ments shall be identified b~:
Obligor name JAVIER PUGA,
Obligee name CINDY ANN MARQUEZ,
OFFICE OF THE ATTORNEY GENERAL case number Ov09Sl92S9,
cause number _f:21_: ?'11<£L:1~~ ___·, wul
the date on which the withholcliru! occurred. ·
lbe Court ORDERS JAVIER I'UGA to pay court costs effl uJJ bJ!iJ to the District Clerk of TARRANT
·r·
County, Texas, on or before the \ day of tY'P--!:::j . 0/[J) 2 .
STATUTOltY WARNINGS
FAILURE TO OBEY A COURT ORDER FOR CHILD SUPPORT OR I''OR POSSESSION OF OR
ACCESS TO A CHILD MAY RESULT IN FURTHER LITIGATION TO ENFORCE THE ORDER,
INCLUDING CONTEMPT OF COURT. A FINDING m· CONTEMPT MAY BE PUNISHED BY
CONFINEMENT IN JAIL FOR UP TO SIX MONTHS, A FII'!E OF UP TO 5500 FOR EACH VIOLATION,
AND A MONEY JUDGMENT FOR PAYMENT OF ATTORNEY'S FEES AND COURT COSTS.
FAILURE OF A PARTY TO MAKE A CHILD SUPPORT PAYMENT TO THE PLACE AND IN THE
MANNER REQUIRED BY A COURT ORDER MAY RESULT IN THE PARTY NOT RECEIVING CREDIT
FOR MAKING THE PAYMENT.
FAILURE OF A PARTY TO PAY CHILD SUPPORT DOES NOT JUSTil Y DENYING THAT PARTY
COURT-ORDERED POSSESSION OF OR ACCESS TO A CHILD. REFUSAL BY A PARTY TO ALLOW
POSSESSION OF OR ACCESS TO A CHILD DOES NOT JUSTIFY l'AJLURE TO PAY COURT·ORDERED
CHILD SUPPORT TO THAT PARTY.
£ACH PERSON WHO IS A PARTY TO THIS ORDER IS ORDERED TO NOTIFY EACH OTHER
PAR1'Y, THE COURT, AND THE STATE CASE REGISTRY OF ANY CHANGE IN THE PARTY'S CURRENT
RESiDENCE ADDRESS, MAILING ADDRESS, HOME TELEPHONE NUM.IIER, NAME OF EMPLOYER,
ADDRLSS OF EMPLOYMENT, DRIVER'S LICENSE NUMBER, AND WORK TELEPHONE NUMBER. THE
PARTY IS ORDERED TO GIVE NOTICE OF AN INTENDED CHANGE IN ANY OF TilE REQUIRED
INFORMATION TO EACH OTHER PARTY, THE COURT, AND THE STATE CASE REGISTRY ON OR
BEFORE THE 60TH DAY BEFORE THE INTENDED CHANGE. IF THE PARTY DOES NOT KNOW OR
COULD NOT HAVE KNOWN OF THE CHANGE IN SUFFICIENT TIME TO PROVIDE 60-DAY NOTICE,
THE PARTY IS ORDERED TO GIVE NOTICE OF THE CHANGE ON OR IBEFORE THE FIFTH DAY
AFTER THE DATE THAT THE PARTY KNOWS OF THE CHANGE.
THE DUTY TO FURNISH TIDS INFORMATION TO EACH OTHER PARTY, THE COURT, AND
THE STATE CASE REGISTRY CONTINUES AS LONG AS ANY PERSON, BY VIRTUE OF THIS ORDER, IS
UNDER AN OBLIGATION TO PAY CHILD SUPP0k{T OR ENTITLED TO POSSESSION OF OR ACCESS
TO A CHILD.
F AlLURE BY A PARTY TO OBEY THE ORDER OF THIS COURT TO PROVIDE EACH OTHER
PARTY, THE COURT AND, THE STATE CASE REGISTRY WITH CHANGE IN THE REQUIRED
INFORMATION MAY RESULT IN FURTHER LITIGATION TO ENFORCE THE ORDER, INCWDI:\"G
CONTEMPT OF COURT. A FINDING OF CONTEMPT MAY BE PUNISHED BY CONFINEME~ TIN JAIL
FOR UP TO SIX MONTHS, A FINE OF UP TO $500 fOR EACH VIOLATION, AND A MONEY JUDGMENT
FOR PAYMENT OF ATTORNEY'S FEES AND COURT COSTS.
COMPANION NOTICE
IT IS ORDERED that each parent subject to this Order has the duty to infonn and shall inform the other parent if
he orshe marries, intends to marry, or resides for at least 30 days \\ith another person {I) he or she knows is registered as
a sex offender under Chapter 62, Texas Code of Criminal Procedure, or (2) who is charged \\ith an offense for which on
C{)nviction that person would be required to register under Chapter 62. Such Notice must be given as soon as practJcable,
but not later than the 40th day after the parent begins to reside with such person, or not later than the
IOth day after the
date of the marriage to such a person. The Notice must include a description of the offense that is the basis of the
person's requirement to register as a sex offender or the offense \\ith which the person is charged.Failure to pro\·uk this
Notice as ordered herein is a Class C misdemeanor.
NOTICE TO THE STATE CASE REGISTRY
As is required by the preceding section, any change of a patty's rcsidcnltal address. mailing address, home
telephone number, name of employer, address of employu~eut, driwr's license number. and work telephone nun1bcr arc to
be reponed by mail to the:
State Case Reg.~stry
Central File Maintenance
P.O. Box 12048
Austin. TX 7871\-2048
in addition to rlljliJllin& the changc(s) to th~ other parties and the Court.
REVIEW
Pursuant to 42 USC 666(tl)( 10), a parent subject to t1 child support order, at least every throo years, has the fi8bt
to request a review of the ordered child support amounts by ()Oil!acling the CHU.D SUPPORT UNIT 0402E oftbc
OFFICE OF 1HE ATTORNEY GENERAL
f 7 467 3PAGE00t;6
INFORMATION PURSUANT TO TEXAS FAMILY (:ODE§ 105.006
Court:
1.. :;.j D/.STRICTCOURTTARRANTCounty, Texas
Cause Number: ~=,! ~ ;-~17 ~-~ -o.;}
PRJMARY JOINT MANAGING or MANAGING CONSEP.VATOR INFORMATION:
Name: CJNDY ANN MARQUEZ
Rllsidence Address: 2352 Tli'HRIHAMCT
FORT WORTH T.X 76106
Mailing Address (if different):
Home Phone: (8 J7) 624-7085
Employer: JIM M & CHJU!.11NA RJOS
Employment Address: POBOX4246
FORT WOR7117X 76/64..()246
Work Phone:
JOINT MANAGING or POSSESSOR\' CONSERVATOR INFORMATION:
Name: JAVJERPUGA
Residence Address: J200 BLALOCK
Fl' WOR7117X 76/ J5
Mailing Address (if different):
Home Phone:
Employer: Lu'\"- <~.k:J).Q-{ Ui'<'', ")·tJI..,, '. I . · ,,
\ .l..
't·
'
!- \_.I,'~- ' ·- i. ., " "'"
...J...~'-L'l-\\:,_·:_'-~- Address _ __
Telephooe Number: -1[\ · I· \- ..\
; · I ··:-; \
Phone Nwnber_ _ _ _ _ __
Employ~r:
Employer Address--------
----
Emj:loy~r Telephone
F7467 3PAGE00tl8
ClRDIR JN svrr Arm:nNO tm PARIN'foCIIIW lliL.tno.'iSIIIP
!J. •
ORDER/NOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT
11!)
0na;..10 Alntndod0 T..,.;,.,_.,
SLate Tel!li.< •
C~./Clty/Oi$1. of l,. "5 ftu.srwqmuARlWiT County
Tnbunal/Casc Number _ ?. 'P) - __ '/.JI.,..:..!J.
(iDirAi.-Y Gro ".':1·1-~
Emp\oyer's/WithholdCI's Nome
Chikl(rll per bl11eekly pay period (e•·ery two week!). S per mouthly pa)· period.
:'>(I:)· ,)'li
REMITTANCE INFORMATION: Wbe~o remli!ID!IIl~yment, provide the pa)· date/date of ,.·lthholdlng and the ease ldcntlr~r. If
the eeployec's/obll&or's principal place of employment Is Texas, begin withholding no latu th!lll the nnt pay period follow;ng
tbe d.u on which this Order/Notice was dellnred to the employer. Sene! payment on the same day of the pay date/dute of
wltblloldln~. The total withheld llltount,lncludlng your fee, cannot uceed !10 %of the employee'slobllKor's aggregate
diJposaiJI• Weeki)' W11lng1.
1l tile ntplnyee'!lobllgor's principal place af employment II not TeUJ, for limitations on withholding, applicable tll'de
requilnlfnts, ed Uly allowable emplo)·er fees, folio..· the laws and procedures of the employee'sJobllgor's principal place of
emplo>-nt (8HII4 Uld JtO, ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS).
1l rusittln11 payiiK·st IJy EI'T/EDJ, call _ _ _ _ _ _ before fint 111bmlulon. Use tbls flPS code:._ __
Bull I'GIItlq code: uk account number: - - - - - - - - - -
f'i.,t7
. .
~PAG£00"02
~ANT: Tile...,_ -pldngllllll'ollllleadviHd thulhelnfllrmatlon onthle form ~lllthiNd wltll tlleotlllgor.
·. .
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
D If checked, you are required to provide a copy of this form to your employee.
If your employee works in a state that is
different from the slate that issued this order, a copy must be provided to your r.mployee a·en if the box is not chL'Cked.
I. We appreciate the volunuuy compliance of Federally recognized Indian tribes, lribally-olflled busiuesses, and lndiar
""led
businesses located on a reservation that choose to withhold in accordant~: with this notice.
2. Priority: Withholding under this Order/Notice has priority over any other legal process under Slate Jay, me
income. If there arc l'ederal tax leviw ~· ~.,
Federal tax levies in effect before receipt of this order have priority. lease
COillaCI the State Child Support Enforcement Agency or party 1istl:d In nwnber 12 below.
3. Combining Paymenu: You can combine ·nithheld amounts from more than one emplO)·ee'slobli.gD!'s income in a single
You m1131, however. separately idtntify the portion of the single payment
payment to each agency/party requesting 11ithholding.
that is attributable to each employee/obligor.
4. Rcj10r1lllg the Paydatc!Datc ofWithboldlng: You must report the paydatcldate of withholding wt·.en sending the payment.
The paydatcldllte ofwithnolding is the date on whk:h the amount was withheld from the employee's wages.You must comply
1\ith the law of the ~tate of employec'slobligo~s prin::ipal pl~~ee of em
Preview
A.G.- F'.W. NCP Name: JAVIER PUGA CENTRAL CP Name: CINDY ANN MARQUEZ OAG NUIIlber: 00095l9l59 CAUSE NUMBER 2?:>\ '33) 1%-0a IN THE INTEREST OF § IN THE '2 ~ I DJSTRJC1' COURT CASANDRA MARIE PUGA § OF A MINOR CHILD § TARRANT COUNTY, TEXAS ~ERIN SUIT AFFECTING THE PARENT-CHI h.. 0.""" D RELATIONSHIP ().,{d/.Q.y 5 o • o<,.O b~ . •U.u/l On th~ ~day of (Y\,e;t.).1 • 20.QJ:_ th · · · v- . v ' .. ~ I ~V f I The OFFICE OF THE ATIORNEY GENERAL appeared by an ASSISTANT ATI'ORNEY GENERAL. CINDY ANN MARQUEZ, mother of the child, social security number 454-57-2778, driver license number 19998397, hereinafter referred to as Obligee, U appeared in person {am! b! a((Orifey-- pn) .s.e._ l; tJ agreed to the entry of these orders as evidenced by her signature; U although duly notified, did not appear. JAVIER PUGA. ALLEGED FATHER of the child, social security uwnber hl j - j! 0-) J.'. 'fuiver license number. f0 D)"~ , hereinafter referred to as Obligor, lY appeared in person (and ll) atton•e: ,OCD S~t l; L.( agreed to the entry of these orders as evidenced by his signature; L1 although duly not1fied, did not appear. The Court fmds that it has julisdiction of the partie• and the subJect matter of this suit, and that the following orders are in the best interest oftm: child. A record of the proceedings was: [3""' waived by the parties with the consent of the court. U made by audio rerording. f 7467 3PAGE0042 PAW:...L.IIPJ1 CHILDREN The following child residing in TARRANT County, 1'X is the subject of this suit: Name Su: DOD SSN CASANDRA MARIE PUGA F 212100 631·70·1849 The Court FINDS thatJAVJER PUGA, the ALLEGED FA711ER of the child, bas a duty of support. CONSERVATORS The Court APPOINTS CINDY ANN MARQUEZ and JA VJER PUGA Joint Managing Conservators of the child. Each parent appointed as a conservator of the cbild bas at all tinres the following rights, privileges, duties, and powers of a plll"lllll: a. of access to medical, dental, psychological and educatioual r.cords of the child; b. to consult with any physician, dentist, or psychologist of the child; c. to consult with school officials conceming the child's welfare and educational status, including school activities: d. to attend school acti,ities; e. to be designated on any records as a person to be notified m cas~ of an emergency; f. to manage the estate of the child to the extent the estate bas been created by the parent or the parent's family: g. to receive infonnation from the other parent conceming the health, education, and welfare of the child: h. to confer with the other parem before making a decision conceming the health, education, and \\elfare of the cbild; i. to consent to medical, dental, and surgical treal>uent durwg an emergency involving an immediate danger to the health and safety of the child; The Court designates CINDY ANN MARQUEZ as the conservator with the exclusive right to detemriue the primary residence of the cbild. The Court orders that CINDY ANN MARQUEZ LJ maintain the child's primary residence in TAiiRANI' county or any contiguous county. [x) may dctennine the child's primary residence without regard to geographic location. The conservator designated with the primary physical residence of the child bas the following exclusive rights, privileges. duties, and powers of a parent; a. the right to the sen'ices and earnings of the child; b. the right to COil!Cllt to marriage, to enlistment in the armed forces of the United States, \0 medicW, dental, and surgical treatment involving invasive procedures, and to psychiatric and psychological treatment; F7467 3PAGE0043 c. the power to represent the child in legal action and to make other decisions of substantial legal signiti1:ance concerning the cl ::d including the right to .:stablish the primary residence of the child; and, d except when a guardian of the child's estate or a guardian or attorney ad litem has been appointed for the child, the power as an agent of the child to act in relation to the child's estate if the child's action is required by a state, the United States, or a foreign government. CINDY ANN MARQUEZ has the cx.clusive right and power to receive and give receipt for periodic payments for the suppoll of the child and to hold or disburse these funds for the benefit of the child. During pmod.s of possession of the child each parc:nt appointed as a conservator of the child r~'lains the following rights, privileges, chuies, w1d powers of a parent, subject to any limitation imposed by court order in allowing a£cess to the child: a. the right to physical possession and to direct the moral and religious training of the child; b. the dut) of care, control, protection, and reasonable discipline of the child; c. the duty to support the cluld. including providing the child with clothing, food, shelter, and medical and dental care not imolving an invasive procedure: d. the right to consent for the child to medical and dental care not involving an invasive procedur,·: and, e. the right to consent to medical, dental and surgical treaunent during an emergency involving an immediate dwtger to the health and safety of the child. VISITATION The Court ORDERS, pursuant to Texas Family Code Chap.:cr 153, JAVIER l'UGA and C/N/JY ANN MARQUEZ to rl:\iew and follow the visttation schedule that is attached to this order Wid incorpomted by reference. F7467 3PAGE0044 STA.'NDARD POSSESSION ORDER DEFINmONS Child The tmn "child" refers to the cllild or children of the parties who are the sub~ of this &ui1 and shall illdudo the plurll fonn whel1cvcr 'lJlpropriato to the ocotcxt. School 'Ibtl tenn "school" rofers to the 1--tihwy or secoodary echool iD. wbidl the child is llllrOllod, or, if the child is not mrollcd in a primary or~ sr.booJ, the public sciMd di.mieginnina at (CHOOSE ONE) ..X.. 6:00 p.!!l. oo the liM, third and fifth Friday of each momh the time the child's sdlool ;is rcg.U.Uly ctiSlllliSCd on the first, third aDd fifth Friday of each momh and ending at (CHOOSE ONE) . X 6:00 p.m, on the follov.~ Sunday. the time school resumes on the following MCIIday. :EM.oc:pt as olhorwise explicitly provided he!"ein, if a weeketld period of possession of Ob!tgor coincides •lith a = scllool holiday during the regular scllool tctru, or with a fedml, sWe, or local boliday dwing the rnontha in which school is not iD. sessioo, the \\·cckbl possessioo shall begin at the regular time Thunday, instead of Friday, for a f'riday buliday llldlor shall ead at the regW.ar time MODday, iD.slead of Sunday, for a Mooday holiday, as applicable. Wedllesdayl. Vbltgor shall ba\-e the right to possession of the child on Wednesdays of each week during the regulu ~~~:boo! tenn begi.Dni.na at (CHOOSl! ONE) .X. 6:00p.m. llld en4i1lg at 8j()() p.m. the time the child's sdlool is regularly dismi•sed llld eodiDg at 8:00p.m. the time the child'elicbool.is regularly diam;•scd llld eodiiJ8 at the time the child's adlool resumes. Sprirl& VIIClliou. Obligor aball haw~ of the child in evC111118llbered yean bcglnnhJill (CHOOSE ONE) ~ 6:00p.m. 011 the day the child i.s disminec! li'cm school for the sdlool's spriDg vaCIIioo tho time IUld 011 the day thb dlild ia ctismjswt fn:rn scbDol for tho sdloc»'s sprina vacati.OII IUld eodilla II (CHOOSE ONB) I f 7 46 7 ~PAGE 00 ·l5 I -~- ..·-- X 6·00 p.m. on the day befmic school RSIIIIIC>O after that vacation. the time and on the day scboolrcswncs after !he school's 4pring vac.ali011. Obltgfl shall have pouessim for the same period tn odd-IWI!Ibemi years. St1.......,. Vawioa.If Obligor gives Obligee writhm lllltice by Aprill of each year specifying 111 exlellded period or paiods of SUiri:IW posscssitm, ~llgor lballllaw ponaoica of1hc child for thirty days beginning 110 ca.dicr thar! !he day aftea' ~ child's s;hool is dismissed for the IIUIIIIIIer Vloelltionl!ld encl.itlj! 110 later than aevCD days prior to !dlool zesumin& at the em!. of the IWDillCr vacllioa, to be ma:r.ised in no more llw1 two acpara!o periods of at least smu C(I!UeCUtjve days w:b If Obligor docs not gi~11 Obligee writtm DOiicc by April! of each year ~ an exttnded period or periods of SWIIIIIer JMX!seWOO. Obligor sba1l bave ~JoSSession of the dlild for thirty COII5tiC:IIIivc days beginning at6:00 p.m. 011 July I and ClldiD,g at 6:00 p.m. on July 31. FW1bemlore, if Ob/lgn gives Obligor wriitm notice by April IS of cach year, Obligee sba1l ba\'C pos.smion of the cbild on any one \\ukend be$inning 816:00 p.m Friday and aulnl8 a16:00 p m. oo the following Sunday durius any 011e exteaded period of SUJI\Il\U·poMCSsion by Obligor, provickd that Oblige• pic:lu! up the clilld from Obligor 811d retlltll81hc child to that same pW:c. Fur!bemlore, if Obllgn gives Obligor written DOiicc by April 15 of each year or gi~ Obligor 14 days writtCD notice 011 or after April 16 of eadl year, Obllgtt may dctigllate ooc \\'CCkmd begiimi.ng no earlier than the day after the child's school is dismissed for the~ Vlllllion and ending rw later that seven days prior to school mumi.na at the Clld of tho sun.mcr vacatioh, chuing whidlan otherwise scbedulcl .:mend period ofposses!ioo by Obltgor will not tab pW:c, provided that the weekeod so dMign•ted docs not interfere with Obligors period or periods of ext.caded SlllliiiW ~sion or with Father's Pay if Ob!Jgor is the fathN" of the child. PA.RE!'"TS WHO RESIDE. OVER 100 MILES APART Except as otherwise elqllicitly provided. if Obltgor resid8s more than 100 miles from the residence of the child, the parents shall have the fi&hta to JX'8.'CS.5iOII of the child as foUows: Wtelwl.ds Obhgor shall bave the right topunessim ufthe child (CHOOSE ONE} oa \\~ beginnina at (CHOOSE ONE) 6,00 p.m em the tint, thiid and fifth Friday of eath IIIOIIIh the time the child'a &chool il fC8\I)arly dill!l!nocl co the lint, tbird and 6tlh ftulay of each lllOil1h lllld eoding at (CiiOOSE ONE) 6:00 p,m. ClOthe 6illowiDa Swday. the time lllbool ~ 011 tho followill& Mooclay• .- "(U~elewl ycm. lbanksaivial- Ob/tgor shall have possession of the chila ... .ldd-IIUIIIbered years beginning at 6:00p.m. on the day tbe cl!i1d ia dismissed rom school be~ ' ThanksgiviDg and ending at 6:00 p .111. on tho followi.o& Sunday, and Obltgu shall have posse$Sioo for the same period in even-numbered years. I Child'• Birthday. The parent uotothen\'ise;emit.led under !his order to prcsc:nt possession ofa child on the cllild's birlhday lhall have possessi.oo oftbe child beginning at 6:00p.m. and ending at 8:00p.m. on that day, provided that said parcat piclcs up the dli1d; from tbc residence of tilt OOO>CIValor entilled to possession and 1' returns tho child to that same place. Father's Day. Tho falher ahalJ ba\'e posseisjon oflho child beginning at 6:00p.m. on the Friday proceding Fatlw's Day and ending at 6:00p.m. 011 Father's Day, provided that, if he is 110t otherwise entitled under thia order to pRSCIIt possession of the child, hapicb up the c:hild fr001 the residence of the conservatorealitled to possessioo and returns tbe clilld to that same place. Mother'• Day. The mochc: shall have ~iOil of the dlild bqj•••ing at 6:00p.m. onlho l'riday ptceeding Mocher's Day and ending at 6:00 p.m. 111 ~olher's Day, provided that, if she is DDI otholwiso Clllitled under tbis ordrt to pmcnt poucaioa oftbe child, siJ p.iob up tbeabildfrom the residaloe oflhe coasorwtor anitled to poswsioollld Rtllrlla lhe child lo the same place. POOR QUALITY ORIGINAL DOCUM£!T F7467 3PAG£0048 ! I GENERiu- TERMS AND CONDITIONS ; ExQePt as Clherwisc ex;licitly provi«~ tenus IUld IXIlditi01111 of possession ofth~ child that apply irrespccrtivcJ oflhB dil1aDGC bclwccll 1M resi4enco of Obligor and 1M priroary rosidl:llco of 1M child arc as fullows: , '1bc provisioas forposacasi011 oftbc child dJ/rin& ~ Thanksaivin& SpriDg VacaliOD, Summer VawiDD, the dlild's biitbday, Falhilf's day,llld Motii¥D ~- llllpii1IXIc auy r4lfli<:liDg wcckCild or W~day periods of ~w. . Wriltta llOCicc sball be !kancd to baw ~timely aivra iflllllCivedor posllllarbd bcfo!1l or at the time that notice is due. Obligee shall~ the child to Ob/igo~ at the beginniDg of each penod of Obligors poesessi011 at Oblig~e's milbce. ' If Obligor ek;;ts to begin a pcriljd ofpollseasim at the time tbe child's school is regularly dismissed, Obllgte dial! swrtlldcr the child to Obllgot at the hegn)nlog of eacll such period ofpossessiOD at lho scliool in which the child i! eorollcd. Obligor shall (CHOOSE ONE) S\lri'Cilder the child to Obltgee at lho eod of each period ofpoasession at the residence of Obligor. .X. return the child to thll rosi~co of Obligee at the end oflhe petiod ofpossessim, except that if Obligors oounty of d0111iclle remains lhe same after the =dillon of this order and if Obligee's oounty of domicile shoold i:haoso, effective oo the dau: of the c:hango of domicile by Obligee, Obligor shall surn.nder th.' chi1d to Oblige~ at 1ho end of each period of possessioo at 1ho If~ltgor elel:ts to eod a period ofposse.5sionat the time lhe child's 11l5iclence of Obligor. scliool resumes, Obligor &ba1l ~ the c:hild to Obligee at the school in v.bich the child is elll'Olled Bach CCUSCI"Uot &ba1l return with the chil~ tho )lOI'&(IIWl effed.s that the child brought at th.c btginnins oflho period •Jf possession. Eilbcr parart may designate any ~ ldult to pick up and relllrn !be cbild, as appli ..able. A parent or a designated ~X~Dpetcnt adult sball be JUCSetd when the child is picked up or returned. A pareat shall give DO!ice to tb.J peroon in posses!ion of the child on each ocwion lhat the panmt will be unable I to ex«Cise that pa.tmt's riabt of posse$sioll for any specified period. ~ failure of a parent to give notioo of an inability to exerr.ise posscssocy rigbU may be COII.Iidmdas a fKtorin a modifir.aliou ot'tbosa JXISSCSSO!)' fi8bls. If a C()DSOI'VIIor'a tinlll of posetuion of a cllild eods at~ timll !lcl!of..! rt.$liiiiCSIIId fur any l?.asoll tbll child is not cooJr.'ltor in pouession of!be child shall imlr.e>Jiately ldfY tbc school or -..ill llDI be 11llll!'ned to sdlool, the and the uhllr CXliiiCI'\'IItor that lhe child \viii DOt boor 1w liOl been Rlwt1td. to school. POOR OUAUlY ORIGINAL OOCUM~T I F7 467 3PAGE~049 I I I CURRENT CHJLD SUPPORT The Court ORDERS JAVIER PUGA to pay CINDY ANN MARQUEZ current child support of S 0] &'0 () each month beginning the I ~i day of 9/J!'N ,'J.D Dd. , payable on or before that date and on or before the same day of each month thereafter while any child is less than 18 years of age or while any child is fully enrolled in an accredited school in a program leading toward a high school diploma or enrolled in courses for joint high school and junior college credit pursuant to Section 130.008, Education Code, whichever occurs lasl, or until every child is othel\vise emancipated. The Court ORDERS JA Y1ER PUGA to pay all child support through the registry prescribed in this decree, and any direct payments by him or any expeoditures incurred during his periods of possession sba1l be deemed in addition to and not in lieu of the child support ordered herein. The Court ORDERS that any pa)mcnts received for the benefit of the child from the Social Security Administration, Veteran's Admir~siration or other similar beoefits, except for income withholding as ordered herein, shall oot be credited against JAV/h'R PUGA's obligation. The Court further ORDERS that the child support provisions of this order shall be an obligation of the estate of JAVIER PUGA, and shall not terminate on his death. Other: --------------------------------------------------------------- f 7467 3PA&E0050 PAu&l OP J1 FINDINGS ON HEALTH INSURANCE AVAll..ABILITY The Court FINDS: (Check only one of the following) _/_ 1. (a) Health insurance is available or is in effect for the child(ren) through JA. VIER PUGA.'s employment or membership in n union, trade assoeiation, or other o·;ganization at a tf'lsonable cost to JAVIER PUGA, and (b) JAVIER PUGA should be ordered to provide sucb insurance. __2. (a) Health insurance is not available for the cbild(ren) thruugh JA. VIER PUGA 's employment; (b) health insurance is available for the child(ren) at a reasonable cost througil CINDY ANN MARQUEZ's employment or membership in a union, trad~ ~ssociation, or other organization; (c) CINDY ANN MARQIIEZ should be ordered to provide such iru;urance; and (d) JAVIER PUGA should be ordered to pay additional child support for the actual cost of such health insurance. __3. (a) Health insurance is not available for the child(ren) at a reasonable cost through JAVIER PlfGA 's nor CINDY ANN MARQUEZ's emplo}ment or membership in a union, trade association, or other organization, (b) health insurance is available to JAVIER PUGA from anotlv'r source at a reasonable cost; and (c) JAVIER PUGA should be ordered to provide such insurance. __4. (a) Neither parent has access to jlrivate health insurance at a reasonable r.ost; (b) CINDY ANN .IMRQUEZ should be ordered to apply immediately or maintain on behalf of the child(ren) for participation in a medical assistance progran· ,Msuant to Chapter 32, Human Resources Code, or the state child health plan pursuant to Chapter 6~. Health and Safety Code; and (c) JAVIER PUGA should be ordered to pay additional child support fo. the actual cost of participation of the cbild(ren) in such progran1. __5. (a) Hc.1lth Coverage is not available for the child under subdivisions I through 4 above, and (b) JAVIER l'VGA should be ordered to pay CINDY ANN MARQUEZ a reasonable amount each month as medical support for the child. __6. Good cause exists to deviate from the statutory priorities in or~. ring health msurancc. '!be Court further finds that the following orders regaoding bcalth insurance are in the best inter~st of the child(reo). F746 73PAGE0051 PAOli lb. or J1 HEALTH INSl'RANCE TO BE PROVIDED BY OBLIGOR As additiocal child support, the Court ORDERS JAVIER PUGA to obtain, within 15 llays after entry of this o"lder, hl'3!tb insU!liJICC for ~h child subject of this suit that covers basic bcalth care services, incl•uliJI!l usual physician scnices, office visits, hospitalization, labo!'lltory, x-ray, and emergen.:y services. The Court ORDERS JAVIER PU&A to maintain such health ins= in full force and effect on each child subje~.'t of this suit as long as child suppo.'t is payable fo; tilat child. The Court ORDERS JAVIER PUGA :o COil\'ert any group insurance to individual covef38C for e11th cl-i!(l within 15 days oftennination of his employment or othe; disqualification of him from the group insurance. Th•: Court ORDERS JAVIER l'llGA to exercise any conversion llptiDIIS in such a manner !hat the resultJng insurance equals or e.xceeds that inunediately before the conversion. The Court ORDERS JAVIER PUGA to furnis:1 CINDY ANN MARQUEZ and the OFFICE OF lliE ATIORNEY GENERAL CHILD SUPPORT UNIT 0402E n true and correct copy oft he health insurance policy or certification :md a schedule of benefits within 30 days oftbe signing of this onler. The Cou t ORDERS JAVII£R PUGA to fumi&h CINDY ANN MARQUEZ the insurance car~s and any other fonns necessary fr •se of the insurance within 30 daye ·~f the signu~g of this ord.r. The Court ORDERS ./A J7ER PUGA to pro•·idc, within th>.:c days of receipt by him, tC' r/NDY Al\"N MARQUEZ any insurance checks, olher payment:.. or C."Planalions ~f benefits relating to any medica .penses for the child that CINDY ,iNN MARQUEZ paid or mcurred. Pursuant to Te'<.iS lnsur:mce Code article 3.96-3. the Court ORDERS that if.JAVIER !'UGA is eligible f.,..r !kpcndant bealth cover~ge. but fails to apply to obtain coverage for the child, the insurer shall enroll the cllild on application of CINDY ANN MARQUEZ or others us authoriud by law. In =rdance with Texas J.r..surancc Code articles 3.5!-13 and 3.96-7, the Court ORDERS that CINDY ANN MARQUEZ, at her option, or ot!:m as authorized by law, may file claims for health-care expenses dirrctly \\ith the insurance· 1rrier. and receive pa)ments from the insurer, \\ith and from whom coverage is provided f0r the benefit ofth.: child. Further, for the sole purpos• of article 3.51-13 of the Texas Insumncc Code, the party who is not carrymg the health insurance policy is designated the managmg consen ator or possessory conservator of the child. UNREII\IUUn5ED HEALTH CARE EXPENSES ibc Court. pursuant to Texas Family Code§ 15·1.183(c), allocates the reasonable and necessary health .:are ~.xpcmes of the child that arc not reunbursed by health insumncc a5 iJIIO\\S: Tne Court ORDERS CINDY A.VN MARQUEZ to pay ..1Q....% and ORDERS JAVIER l'UGA to pay .J.Q_% of the unreimburscd health care expenses if. at the time the expenses arc incurred, the party ordered to provi1e health insaran.:e for the child is providing healtl1 inswanoe as orde.red. WARNING A parent ordered to provide bulth insurance who fails to do so is liable for 100% of nett.·ssary medical apensa of the cbild, without rqard to whether the expenses would have been paid if be·' !: :..surance hal' been p:ovided. and the cost of health insw'allte premlu111.1 or cuntribulions, if any, paid on l>ehalf oftbe child. The Court ORDERS the~- who incurs a health care expense on behalf of the child to submit to the .!her party -s within 30 day£ after all forms, receipts, bills, and staterneats reflecting the uninsured portion of the health care ex; ·; be or she receives them. The Coort ORDEI\S the 11011-incurring party to pay his or her percent'lgll of the uninsured portion of the health care expemcs ci%bet by paying the health care provider directly or by reimbursing the incurrirg party for any advance pa~ment o\·er and ;abo\-e the incurring party's percentage of the uninsured portion of the health care cxpmscs Y.ithin 30 days after the noa-iDc ·:ring party reo:ives the forms, r=ipts, bills, or staleiMll!!. These provisions apply to ail unreimbursed health we expenses of any child subject of ulis suit that arc iru:urred v.hile child IIIPJlOrt is pa)'ablc for !hal c:hiid. f 7 467 3PAGE0052 CHILD SUPPORT GUIDELINE FINDINGS The Court FINDS, pursuant to TCXliS Family Cede§ 154.130: (I) the monthly net resources of the OBLIGOR per mooth are S \ .3 ~;) •O\ (2) the monthly net resources of the OBLIGEE per mooth areS N fr ; (3) the percentage applied to the OBLIGOR'S net resources for rhild suppott by the actual order renderetl by the Court is dl> %; (4) the am~\lllt of child support if the pera:lllage gui«Wincs W'C applied to the first $6,000 of the OBLIGOR'S net res Jurces is $ p /{..:;: l)() : (5) if applicable. the specific reasons that the amount of child support per month ordered by the coutt vanes from the amount stated in Subdivision (4) arc: u the Court ordered OBLIGOR to pay an additional s.____ per month current child support bet:ause OBLIGEE is ordered to rrovide health insurance; and u the Court subtracted benefits of$ _ __ p e r - - - - paid to or for the child as a result of the OBLIGOR'S disability: and u ------------------·--------------------------------~·~d (6) if applicable. the OBLIGOR is obligated to &upport chtl:ircn in more than one household, and: (A) the number of children before the court is _I_ (B) the number of children not before the court restding m the same household with the OBi..IGOR is (};and (C) the number of children not before the court fur whom the OBLIGOR is obligated b~ a court order to l>'lY suppol't, \vithout regard to whether the OBLIGOR is delinquent in child support payments, and who are not counted under Paragraph (A) or (B) is .1:1_. f 7 467 3PAGE00G3 P.uaJl.orD RETROACTIVE CHILD SUPPORT The Court FINDS that retroactive child support should be ordered, in the amount ofS 'f>J.)\ , li b as of ffi~\Jo , 0@~ , and that the retroactive child support is assigulld to the OFFICE OF THE ATTORNEY GENeRAL pursuant to Texas Family Code Chapter 231. The Court GRANTS JUDGMENT a&ainstJAVIER PUGA and in favor of the OFFICE OF THE ATTORNEY GENERAL in the amount of S q; d- '6 • () u with interest a1 the rate provided by law, for collection and distribution according to law. The Court ORDERS JAVIER PUGA, the Obligor, to pay said child support judgment \l)"fJAYill!" aud by paying S----- S 49· 0 U on or lii:Tore the _nay of ~;ach month beginning the~ day of ;:i fM:,Q , Ch\))J., payable on or IK.fore that date and oo orb~fore the same day of each month ther ~until the arrearage is paid in full, or oa the termination of current support for any child the subject of this suit. If JAVIER PVGA has not paid the judgment in full by the date his current child support obligation ends, the Court ORDERS him to pay the remainder of said judgment by paying$_ 3a, $'", 6,) each month on or before th~ same day of each month until the arrearage is paid in full. TI1e withholding order authorized herein shall include such pa)ments. but nothing herein shall prohibit the usc of other collection methods authorized by law. F7 467 3PAGE00~4 ORDER IN SUIT Arnc:tiNO 1111 P,uwaoCIIllD IWATIONIIIII' INCOME WITHHOLDING The Court ORDERS, pursuant to Texas Family Code Chapter 158, any employer of JAVIER PVGA, current or subst:quent, to withhold income from the disposable earnings of JAVIER PUGA for the child's support as set out in the ORDERINOTICF TO WITHHOLD INCOME FOR CIDLD SUPPORT entered herein. Any income withheld from JAVIER PUGA's disposable earnings tor child support and paid according to this order shall be credited against his child support obligation, but shall not discharge any of his child support obligation that exceeds the amount so credited. The Court ORDERS the Clerk of the Court, upon request, tc cause a certified copy of the ORDER/NOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT, with a copy ofTexas Family Code Chapter !58 attached, to be deliv.:red tc JAVIER PUGA's employer. The Court ORDERS JAVIER PUGA to provide any subsequent employer with a copy of the ORDER/NOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT entered herein. PA\"MENT OF SUPPORT AND COSTS The Court ORDERS JAVIER PUGA to pay all support t" the registry of the court: Texas Child Support Disb•uscmcnt Unit P0 Box 659791 San Antonio, TX 78265·979 J for distribution according tl'law. All pa)ments shall be identified b~: Obligor name JAVIER PUGA, Obligee name CINDY ANN MARQUEZ, OFFICE OF THE ATTORNEY GENERAL case number Ov09Sl92S9, cause number _f:21_: ?'11<£L:1~~ ___·, wul the date on which the withholcliru! occurred. · lbe Court ORDERS JAVIER I'UGA to pay court costs effl uJJ bJ!iJ to the District Clerk of TARRANT ·r· County, Texas, on or before the \ day of tY'P--!:::j . 0/[J) 2 . STATUTOltY WARNINGS FAILURE TO OBEY A COURT ORDER FOR CHILD SUPPORT OR I''OR POSSESSION OF OR ACCESS TO A CHILD MAY RESULT IN FURTHER LITIGATION TO ENFORCE THE ORDER, INCLUDING CONTEMPT OF COURT. A FINDING m· CONTEMPT MAY BE PUNISHED BY CONFINEMENT IN JAIL FOR UP TO SIX MONTHS, A FII'!E OF UP TO 5500 FOR EACH VIOLATION, AND A MONEY JUDGMENT FOR PAYMENT OF ATTORNEY'S FEES AND COURT COSTS. FAILURE OF A PARTY TO MAKE A CHILD SUPPORT PAYMENT TO THE PLACE AND IN THE MANNER REQUIRED BY A COURT ORDER MAY RESULT IN THE PARTY NOT RECEIVING CREDIT FOR MAKING THE PAYMENT. FAILURE OF A PARTY TO PAY CHILD SUPPORT DOES NOT JUSTil Y DENYING THAT PARTY COURT-ORDERED POSSESSION OF OR ACCESS TO A CHILD. REFUSAL BY A PARTY TO ALLOW POSSESSION OF OR ACCESS TO A CHILD DOES NOT JUSTIFY l'AJLURE TO PAY COURT·ORDERED CHILD SUPPORT TO THAT PARTY. £ACH PERSON WHO IS A PARTY TO THIS ORDER IS ORDERED TO NOTIFY EACH OTHER PAR1'Y, THE COURT, AND THE STATE CASE REGISTRY OF ANY CHANGE IN THE PARTY'S CURRENT RESiDENCE ADDRESS, MAILING ADDRESS, HOME TELEPHONE NUM.IIER, NAME OF EMPLOYER, ADDRLSS OF EMPLOYMENT, DRIVER'S LICENSE NUMBER, AND WORK TELEPHONE NUMBER. THE PARTY IS ORDERED TO GIVE NOTICE OF AN INTENDED CHANGE IN ANY OF TilE REQUIRED INFORMATION TO EACH OTHER PARTY, THE COURT, AND THE STATE CASE REGISTRY ON OR BEFORE THE 60TH DAY BEFORE THE INTENDED CHANGE. IF THE PARTY DOES NOT KNOW OR COULD NOT HAVE KNOWN OF THE CHANGE IN SUFFICIENT TIME TO PROVIDE 60-DAY NOTICE, THE PARTY IS ORDERED TO GIVE NOTICE OF THE CHANGE ON OR IBEFORE THE FIFTH DAY AFTER THE DATE THAT THE PARTY KNOWS OF THE CHANGE. THE DUTY TO FURNISH TIDS INFORMATION TO EACH OTHER PARTY, THE COURT, AND THE STATE CASE REGISTRY CONTINUES AS LONG AS ANY PERSON, BY VIRTUE OF THIS ORDER, IS UNDER AN OBLIGATION TO PAY CHILD SUPP0k{T OR ENTITLED TO POSSESSION OF OR ACCESS TO A CHILD. F AlLURE BY A PARTY TO OBEY THE ORDER OF THIS COURT TO PROVIDE EACH OTHER PARTY, THE COURT AND, THE STATE CASE REGISTRY WITH CHANGE IN THE REQUIRED INFORMATION MAY RESULT IN FURTHER LITIGATION TO ENFORCE THE ORDER, INCWDI:\"G CONTEMPT OF COURT. A FINDING OF CONTEMPT MAY BE PUNISHED BY CONFINEME~ TIN JAIL FOR UP TO SIX MONTHS, A FINE OF UP TO $500 fOR EACH VIOLATION, AND A MONEY JUDGMENT FOR PAYMENT OF ATTORNEY'S FEES AND COURT COSTS. COMPANION NOTICE IT IS ORDERED that each parent subject to this Order has the duty to infonn and shall inform the other parent if he orshe marries, intends to marry, or resides for at least 30 days \\ith another person {I) he or she knows is registered as a sex offender under Chapter 62, Texas Code of Criminal Procedure, or (2) who is charged \\ith an offense for which on C{)nviction that person would be required to register under Chapter 62. Such Notice must be given as soon as practJcable, but not later than the 40th day after the parent begins to reside with such person, or not later than the IOth day after the date of the marriage to such a person. The Notice must include a description of the offense that is the basis of the person's requirement to register as a sex offender or the offense \\ith which the person is charged.Failure to pro\·uk this Notice as ordered herein is a Class C misdemeanor. NOTICE TO THE STATE CASE REGISTRY As is required by the preceding section, any change of a patty's rcsidcnltal address. mailing address, home telephone number, name of employer, address of employu~eut, driwr's license number. and work telephone nun1bcr arc to be reponed by mail to the: State Case Reg.~stry Central File Maintenance P.O. Box 12048 Austin. TX 7871\-2048 in addition to rlljliJllin& the changc(s) to th~ other parties and the Court. REVIEW Pursuant to 42 USC 666(tl)( 10), a parent subject to t1 child support order, at least every throo years, has the fi8bt to request a review of the ordered child support amounts by ()Oil!acling the CHU.D SUPPORT UNIT 0402E oftbc OFFICE OF 1HE ATTORNEY GENERAL f 7 467 3PAGE00t;6 INFORMATION PURSUANT TO TEXAS FAMILY (:ODE§ 105.006 Court: 1.. :;.j D/.STRICTCOURTTARRANTCounty, Texas Cause Number: ~=,! ~ ;-~17 ~-~ -o.;} PRJMARY JOINT MANAGING or MANAGING CONSEP.VATOR INFORMATION: Name: CJNDY ANN MARQUEZ Rllsidence Address: 2352 Tli'HRIHAMCT FORT WORTH T.X 76106 Mailing Address (if different): Home Phone: (8 J7) 624-7085 Employer: JIM M & CHJU!.11NA RJOS Employment Address: POBOX4246 FORT WOR7117X 76/64..()246 Work Phone: JOINT MANAGING or POSSESSOR\' CONSERVATOR INFORMATION: Name: JAVJERPUGA Residence Address: J200 BLALOCK Fl' WOR7117X 76/ J5 Mailing Address (if different): Home Phone: Employer: Lu'\"- <~.k:J).Q-{ Ui'<'', ")·tJI..,, '. I . · ,, \ .l.. 't· ' !- \_.I,'~- ' ·- i. ., " "'" ...J...~'-L'l-\\:,_·:_'-~- Address _ __ Telephooe Number: -1[\ · I· \- ..\ ; · I ··:-; \ Phone Nwnber_ _ _ _ _ __ Employ~r: Employer Address-------- ---- Emj:loy~r Telephone F7467 3PAGE00tl8 ClRDIR JN svrr Arm:nNO tm PARIN'foCIIIW lliL.tno.'iSIIIP !J. • ORDER/NOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT 11!) 0na;..10 Alntndod0 T..,.;,.,_., SLate Tel!li.< • C~./Clty/Oi$1. of l,. "5 ftu.srwqmuARlWiT County Tnbunal/Casc Number _ ?. 'P) - __ '/.JI.,..:..!J. (iDirAi.-Y Gro ".':1·1-~ Emp\oyer's/WithholdCI's Nome Chikl(rll per bl11eekly pay period (e•·ery two week!). S per mouthly pa)· period. :'>(I:)· ,)'li REMITTANCE INFORMATION: Wbe~o remli!ID!IIl~yment, provide the pa)· date/date of ,.·lthholdlng and the ease ldcntlr~r. If the eeployec's/obll&or's principal place of employment Is Texas, begin withholding no latu th!lll the nnt pay period follow;ng tbe d.u on which this Order/Notice was dellnred to the employer. Sene! payment on the same day of the pay date/dute of wltblloldln~. The total withheld llltount,lncludlng your fee, cannot uceed !10 %of the employee'slobllKor's aggregate diJposaiJI• Weeki)' W11lng1. 1l tile ntplnyee'!lobllgor's principal place af employment II not TeUJ, for limitations on withholding, applicable tll'de requilnlfnts, ed Uly allowable emplo)·er fees, folio..· the laws and procedures of the employee'sJobllgor's principal place of emplo>-nt (8HII4 Uld JtO, ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS). 1l rusittln11 payiiK·st IJy EI'T/EDJ, call _ _ _ _ _ _ before fint 111bmlulon. Use tbls flPS code:._ __ Bull I'GIItlq code: uk account number: - - - - - - - - - - f'i.,t7 . . ~PAG£00"02 ~ANT: Tile...,_ -pldngllllll'ollllleadviHd thulhelnfllrmatlon onthle form ~lllthiNd wltll tlleotlllgor. ·. . ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS D If checked, you are required to provide a copy of this form to your employee. If your employee works in a state that is different from the slate that issued this order, a copy must be provided to your r.mployee a·en if the box is not chL'Cked. I. We appreciate the volunuuy compliance of Federally recognized Indian tribes, lribally-olflled busiuesses, and lndiar ""led businesses located on a reservation that choose to withhold in accordant~: with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under Slate Jay, me income. If there arc l'ederal tax leviw ~· ~., Federal tax levies in effect before receipt of this order have priority. lease COillaCI the State Child Support Enforcement Agency or party 1istl:d In nwnber 12 below. 3. Combining Paymenu: You can combine ·nithheld amounts from more than one emplO)·ee'slobli.gD!'s income in a single You m1131, however. separately idtntify the portion of the single payment payment to each agency/party requesting 11ithholding. that is attributable to each employee/obligor. 4. Rcj10r1lllg the Paydatc!Datc ofWithboldlng: You must report the paydatcldate of withholding wt·.en sending the payment. The paydatcldllte ofwithnolding is the date on whk:h the amount was withheld from the employee's wages.You must comply 1\ith the law of the ~tate of employec'slobligo~s prin::ipal pl~~ee of em