Sifferman V. Sifferman 04 3 02210 1 Casefile Part 3

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.....-.-.,. ~·F· II ED . 2011 JAN 21 PM I: 31 2 3 IIIHJJ!ff!fIll SOHYA KRASril COUNTY CLERK ~NOHOMISH CD. W/1.SH 4 s 6 Superior Court of Washington 7 County of…
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.....-.-.,. ~·F· II ED . 2011 JAN 21 PM I: 31 2 3 IIIHJJ!ff!fIll SOHYA KRASril COUNTY CLERK ~NOHOMISH CD. W/1.SH 4 s 6 Superior Court of Washington 7 County of Snohomish 8 In re the Marriage of: No. 04-3-02210-1 9 GREGORY ALAN SIFFERMAN, Petitioner, Order of Child Support 10 and 11 Final Order (ORS) SUSAN BEIB HUMPHREY, 12 Res ondent. Clerk's Action Re uire,I 13 I. Judgment Summary 14 1.1 Judgment Summary for Non-Medical Expenses Applies as follows: IS A. Judgment creditor Susan BeU1 Humphrey 16 B. Judgment debtor Grego1y Alan Siffennan C. Principal judgment amount (back child support/other obligations) $ 17 from 5/20 IO through 9/20 I 0 D. Interest to date ofjudgment $ 18 E. Attorney fees $ F. Costs $ 380.15 19 G. Other recove1y amount $ 20 H. Principal judgment shall bear interest at 12% per annum I. Attorney fees, costs and other recovery amounts shaU bear interest at I 2% per annum 21 J. Attorney for judgment creditor Jan Dyer K. Attorney for judgment debtor Gail Nunn 22 1.2 Judgment Summary for Medical Support 23 Applies as follows: A. Judgment creditor Susan Beth Humphrey 24 B. Judgment debtor Gregory Alan Sifferman C. Judgment for medical support from 7/2009 through 11/3/2010 $2,985.00 2S D. Interest to date ofjudgment $ E. Attorney fees $ 26 F. Costs $ @;;; G. Principal judgment shaU bear interest at 12 % per annum 27 (cQl) H. Attorney fees, costs and other recove1y amounts shall bear interest at 12 % per annum (!J>1) 28 ~ Order ofChild S11pport (I'MORS, ORS)· Page I of JO N ,.. I Dl'ER & PRIAIO.VT WPF DR 0/.0500 ,\fa11dafo1y (6120/0) - RCW 26.09./75; 26.26.(32 0 R\ G' J'\f4t: A,·e. E, Sftillle, WA 98101 (106) 313-1S28 I. Attorney for judgment creditor Jan Dyer J. Attorney for judgment debtor Gail Nunn 2 K. Other 3 II, Basis 4 2.1 Ty11e of Proceediug 5 This order is entered under a order for modification of a parenting plan. 6 2.2 Child Suppol't Wo1·ksheet 7 The child support worksheet which has been approved by the court is attached to this order and is 8 incorporated by reference or has been initialed and filed separately and is incorporated by reference. 9 2.3 Othe1· 10 III. Findings and Order 11 It Is Ordered: 12 3.1 Cbildreu fol' Whom S11ppo11 Is Requh·ed 13 14 Name Age Lauren 16 15 Zachary 11 Annalisa 9 16 3.2 Person Paying Support (Obllgo,·) 17 Name: Gregory Alan Sifferman 18 Birth date: 06-18-1962 19 Service Address: 23327 19"' Dr. SE, Bothell, WA 98021 20 Tlte Obligor Pare11t Must Immediately File Wit/, the Court mu/ the Wasll/11gto11 Slllle Child Support Registry, rmd Uprlate as Necessary, the Co11fide11tial lttfor111atlo11 Form Required by 21 RCW 26.23.050. . The Obligor Parent Shall Update lite I,tformatio11 Required by Paragraph 3.2 Promptly After 22 a11;• Change 111 the /11for111atlo11. Tlte Duty to Updllte the Information Co11ti11ues as /011g as a11y Support Debt Re11111/11s tl11e U11der TJ,Js Order. 23 24 For purposes of this Order of Child Supp01t, the support obligation is based upon the following 25 income: 26 Actual Monthly Net Income:$ 3,041. 27 The Father shall provide updated income information each year. He shall provide his W2 by 28 Oi'lf<r o/Cilild S11ppm1 (T,\IORS, ORS}-Page 2 of /0 Dl'ER&PRJMONT ll'PF DR 0/.0500 Mandatory (612010) • RCIJ' 16.09.175; 503 Twe(/lh 1h'l!'. E, Sea11/e, WA 98101 26.16./32 (106) 3'J-JS18 January 31'1 and he shall provide a copy of his income tax return, including all schedules, by April 31" each year. Father receives commission and his income varies from year to year. 2 3 4 3.3 Person Receiving Sup11ort (Obllgee) s Name: Susan Beth Humphrey Birth date: 07-08-1963 6 Service Address: 23727 22nd Drive SE, Bothell, WA 98021 7 Tlte Obi/gee Must lmmetl/ately File Wit/1 the Court and the Washlngto11 State Cit/Id Support 8 Registry and Update as Necessary t!,e Conjlde11tla/ Information Form Required by RCW 26.23.050. 9 Tfte Obi/gee Sltall Update tfte l,iformat/011 Required by Paragrapft 3.3 Promptly After m,y 10 Cltange 111 the l1tfornmtlon. Tfte DulJ• to Update the /Jtformatlon Continues as Lo11g as any Montltly Support Remains Due or any Unpaid Support Debt Remains Due Under Tftls Order. II For purposes of this Order of Child Support, the suppo1t obligation is based upon the following 12 income: 13 Actual monthly Net Income:$ 1,774.60. 14 The obligor may be able to seek reimbursement for day care or special child rearing expenses not IS actually incurred. RCW 26.19.080. 16 3.4 Se1-vice of Process 17 Service ofProcess 011 tlte Obligor al tlte Adtlress Required by Paragraplt 3,2 or a11y Updated Address, or 011 tlte Obi/gee at //re Adrlress Required by Paragraph 3.3 or a11y Updated Address, 18 11111y Be Allowed or Accepted as At/equate in any Proceedl11g to Estabflslt, Enforce or Motlljj, a 19 Clti/tl Support Order Between tlte Parties by Delivery of Wr//ten Notice to tlte Ob/Igor or Obi/gee at /he Last Address Provided. 20 3.5 Transfer Payment 21 111e obligor parent shall pay the following amounts per month for the following children: 22 Amount 23 24 Lauren $572.00 Zachary $463.00 25 Annalisa $463.00 26 Total Mont/tty Transfer Amount $900.00 27 Tlte Obligor Parent's Privileges to Obtaht or Maintain a License, Certijlcate, Reglstrat/011, 28 Order ofChild Support (J'MORS, ORS} - Page 3 of 10 DYER & PR/MONT Jl'PF DR 01.0500 Ma11datory (611010} - RCW 26.09.175; 503 Ttrtljlh,,1\-t. E. SM11k, IY.4 98102 26.16./32 (104) Jl!J..I '28 . Permit, Approvt1f, or Other Similar Docume111 Issued by a Llcensi11g E11tity Evide11clng Admlsslo11 to or Gra11ti11g Authority lo Engage l,1 a Profess/011, Occ11patlo11, B11sl11ess, 2 I11d11slry, Recreatio11af P11rs11lt, or the Operat/011 ofa Motor Vehicle may Be Denied or may Be Suspended If the Obligor Pare11t ls 110/ /11 Complia11ce Witt, Tltls S11pporl Order as Provided In 3 Chapter 74.20A Revised Code of Washington. 4 3.6 Standard Calculation 5 $900.00 per month. (See Worksheet line 17.) 6 3.7 Reasons for Deviation F,·om Standard Calculation 7 The child support amount ordered in paragraph 3.5 does not deviate from the standard 8 calculation. 9 3.8 Reasons why Request for Deviation Was Denied JO A deviation was not requested. II 3.9 Starting Date and Day to Be Paid 12 Sta11ing Date: February l, 2011 13 1• Day(s) of the month support is due: 14 3.10 Incremental Payments 15 Does not apply. 16 3,11 Making Support Payments 17 Direct Payment: Support payments shall be made directly to: 18 19 Susan Beth Humphrey 23727 22°" Dr. SE 20 Bothell, WA 98021 Or 21 Direct Deposit into: Respondent's bank account 22 A party required to make payments to the Washington State Suppmt Registry will not receive credit fur a payment made to any other party or entity. The obligor parent shall keep the registry 23 infonned whether he or she has access to heallh insurance coverage at l"easonable cost and, if so, 24 to provide the health insurance policy information. 25 Any time the Division of Child Suppot1 is providing support enfo1·cement services under RCW 26.23.045, or if a pa,ty is applying for suppmt enforcement services by signing the 26 application fom1 on the bottom of the support order, the receiving parent might be required to submit au accounting of how the support, including any cash medical support, is being spent to 27 benefit the children. 28 Order ofChild Support (TMORS. ORS) - Pag, 4 of JO D}'ER & PR/MONT WPF DR 01.0500 Monda/my (611010) - RCIY 26.09.175; $03 Twelft/111\'~. E. S«111/e, JYA 98/01 26.26./32 (106) 313-IS18 3.12 Wage Witbholdlng Action 2 Withholding action may be taken against wages, eamings, assets, or benefits, and liens enforced 3 against real and personal property under the child support statutes of this or any other state, 4 without further uotice to the obliger parent at any time after entry of this order. 5 3.13 Termination of Support 6 Suppo1t shall be paid until the child reaches the age of 18 or until the child's prior death, man·iage, emancipation. In the event the child is living at home, attending high school full time, 7 and has not yet reached the age of 19, child support shall continue until the child graduates from high school or reaches the age of 19, whichever occurs first, except as otherwise provided below 8 in Paragraph 3.14. 9 3.14 Post Secondary Educafional S11ppo1·t 10 Each parent agrees to pay a portion of the children's college educational and room and board 11 expenses. The exact amounts and contributions of each parent and each child shall be determined by agreement or through mediation or arbitration. 12 3.15 Payment for Expenses not Included In tile Transfer Payment 13 14 The petitioner shall pay 64% and the respondent 36 % (each parent's proportional share of income from the Child Support Schedule Worksheet, line 6) of the following expenses incurred IS on behalfofthe children listed in Paragraph 3.1.: 16 Educational expenses 17 Payments shall be made to the provider of the se1vice whenever possible, otherwise to the parent receiving the transfer payment. 18 19 3.16 Periodic Adjustment 20 Does not apply. 21 3.17 Income Tax Exeml'tious 22 In even years mother receives exemptions fo,· two children and father receives one exemption; in odd years father receives exemptions for two children and mother receives one ex.emption. 23 24 When only two children are available each parent receives one exemption. 25 When only one child is available: The exemptions shall alternate yearly beginning with the mother. 26 Father shall only be entitled to the tax exemptions for die children if he is current in his child 27 support, including all out of pocket health care and educational expenses owed to the mother on 28 Order ofChl/d Support (TMORS. ORS) - Page S of 10 Dl'liR & PRJAfONT ll'PF DR 0/.0500 Mn11dntory (612010) - RCII' 16.09./75: S03 nre(J1h Al'e. £. ~a/lie. WA 98102 26.16.132 (106) 313-/ J18 December 3 I". Ifhe is not cummt on December 31", the mother shall receive all of the tax exemptions for the children that year. 2 3 3.18 Medical Support - Health ltlsurnuce 4 Each parent shall provide health insurance coverage for the children listed in paragraph 3.1, as s follows: 6 3.18.1 Health Ins,mrnce (either check box A(l), or check box A(2) and complete sections B and C. Section D applies In all cases.) 7 8 There is sufficient evidence for the com1 to determine which parent must provide coverage and which parent must contribute a sum certain. Fill in Band C below. 9 B. Findings about insurance: IO The court makes the following findings: 11 .H---------~-----~--~--------------------+. Susan Beth Humphrey G!'egory Alan 12 Sifferman Check at least one of the following findings for each arent. 13 Insurance coverage for the children is available l!!J!! [) accessible to this parent at $877.43 cost (children's 14 ortion of the remium on! . Insurance coverage for the children is available and accessible to this parent at $178 cost (children's portion ofthe remium on! . Insurance coverage for the children is available but not 17 [1 accessible to this parent al$...,... cost (children's ortion of the remim onl . 18 Insurance coverage for the children is available !1l!tru!! accessible to this parent at$. cost (children's 19 >ortion of the remium on! . 20 Neither parent has available or accessible insurance through an employer or union; but this parent is able to 21 provide private coverage at a cost not to exceed 25¾ of this arent's basic su ort obli ation. 22 Neither parent has available or accessible insurance [ ) through an emp]oyer or union; but this parent is able to 23 provide private coverage at a cost not to exceed 25¾ of 24 this arenl's basic su ort obli ation. (Check only one parent) Both parties have available and 25 [1 [ ] accessible coverage for the children. The court finds that this parent has better coverage considering the needs of 26 the children, the cost and extent of each parent's covers e and the accessibili of the covera e. 27 28 Order ofChild Suppo,·t {TMORS. ORS)· Page 6 of JO DYER & PRJMONT WPF DR 01.0500 Mandato,y (612010) • RCII' 16.09.175; SOJ nre(/Jh Aw:. E. Statrlt, WA 98/01 26.26.131 (106) 343-1 J]8 2 3 C. Parties' obligations: 4 The court makes the followin<> orders: s Susan Beth Grego1y Alan Chee!< Rt lcRSt one of the following options for each Humohrey Siffennan nal'ent. 6 This parent shall provide health insurance coverage for [l [l the children that is available through employment or· is 7 union-relRted as long as the cost of such coverage 8 does not exceed 25% of this parent's basic support oblillation. 9 This parent shall provide health insurance coverage for [l [x.] the children that is available through em11loyment or is 10 union-related even though the cost of such coverage exceeds 25% of this parent's basic support obligation. II It is in the best interests of the children to provide such covera"e desnite the cost. 12 This parent shall provide p1·ivate health insurance 13 [l l l coverage for the children as long as the cost of such coverage does not exceed 25¾ of this parent's basic 14 sunnort obli<>ation. This parent shall provide private health insurance IS l l [ l coverage for the children even though the cost of such coverage exceeds 25¾ of this parent's basic support 16 obligation. It is in the best interests of the children to provide such coverage despite the cost because: 17 18 This parent shall pay $ towards the health 19 [J [l insurance premium being paid by the other parent. This amount is this parent's proportionate share of the 20 premium or 25% of this parent's basic support obligation, whichever is less. This payment is only 21 required if this parent is not providing insurance as described above. 22 This parent,s contribution to the health insurance 23 [x.J [X] premium is calculated in the Worksheet and included in the transfer payment. 24 This parent shall be excused from the responsibility to 25 [I [ ] provide health insurance coverage and from the responsibility to provide monthly payment towards the 26 premium because: 27 28 Order ofChild Support (T'MORS. ORS) - Page 7 of JO DYER & PRJAIONT WPF DR 01.0J00 Mandatory (6120/0) - RCW 26.09.l7J; SOJ n..elfth Al't:. E, Smule, WA 98101 26.16./31 (206) 343,/528 I I (Onlv one oarent mav be excused.) 2 3 D. Both parties' obligation: 4 If the children are receiving state financed medical coverage, the Division of Child Support may enforce the responsible parent's monthly premium. s The parent(s) shall maintain health insurance coverage, if available for the children listed 6 in pm-agraph 3.1, until further order of the court or until health insurance is no longer available through the parents' employer or union and no conversion privileges exist to 7 continue coverage following termination of employment. 8 A parent who is required under this order to provide health insurance coverage is liable 9 for any covered health care costs for which that parent receives direct payment from an insurer. 10 A parent who is required under this order to provide health insurance coverage shall II provide proof that such coverage is available or not available within 20 days of the entry of this order to the other parent or the Washington State Support Registry if the parent 12 bas been notified or ordered to make payments to the Washington State Support Registry. 13 If proof that health insurance coverage is available or not available is not provided within 14 20 days, the parent seeking enforcement or the Department of Social and Health Services may seek direct enforcement of the coverage through the other parent's employer or IS union without further notice to the other parent as provided under Chapter 26.18 RCW. 16 3.18.2 Change of Circumstances and Enforcement 17 A parent required to provide health insurance coverage must notify both the Division of Child 18 Support and the other parent when coverage terminates. 19 If the parents' circumstances change, or if the court has not specified how medical suppo11 shall be provided, the parents' medical support obligations will be enforced as provided in 20 RCW 26.18.170. If a parent does not provide proof of accessible coverage for the children through private insurance, a parent may be required to satisfy his or her medical support 21 obligation by doing one of the following, listed in order of priority: 22 I) Providing or maintaining health insurance coverage through the parent's employment or 23 union at a cost not to exceed 25% of that parent's basic support obligation; 2) Contributing the parent's proportionate share of a monthly premium being paid by the 24 other parent for health insurance coverage for the children listed in p81'8graph 3. I of this order, not to exceed 25% of the obligated parent's basic support obligation; or 2S 3) Contributing the parent's proportionate share ofa monthly premium paid by the state if the children receive state-financed medical coverage through DSHS under RCW 74.09 26 for which there is an assignment. 27 A parent seeking to enforce the obligation to provide health insurance coverage may apply for 28 Order ofChild Support (l'MORS. ORS)- Page 8 of 10 DYfiR & PRJAIONT WPF DR 0/.0j00 Ma11dn101y (61]0/0) - RCII' 26.09./7j; JOJ T11v:I/Jh Ar~. E, Seau/e, W,J 98101 26.26./32 (206) 3J3-JS18 support enforcement services from the Division of Child Suppo11; file a motion for contempt (use fonn WPF DRPSCU 05.0100, Motion/Declaration for an Order to Show Cause re Contempt); or 2 file a petition. 3 3.19 Uninsured Medical Expenses 4 Both parents have an obligation to pay their share of uninsured medical expenses. 5 The petitioner shall pay 64% of uninsured medical expenses (unless stated othe1wise, the 6 petitioner's prop011ional share of income from the Worksheet, line 6) and the respondent shall pay 36% ofuninsmed medical expenses (unless stated otherwise, the respondent's 7 proportional share of income from the Worksheet, line 6). 8 3.20 Back Child Support 9 Back child support that may be owed is not affected by this order. 10 Back interest that may be owed is not affected by this order. II 3.21 Past Due Ui1paid Medical Support 12 Susan Beth Humphrey is awarded judgment against Gregory Alan Sifferman in the amount of 13 $298S.00 for past due unpaid medical suppo11 for the period from November 2009 through November 3 20 I 0. This is the most the father would owe with no reimbursement from Premera. 14 This figure may be offset by any amounts the mod1er receives from insurance reimbursements for treatments between those dates from die father's insurance company and it shall be offset by $50 15 contempt citation owed by the mother. 16 3.22 Other Unpaid Obligations 17 Susan Beth Humphrey is awarded judgment against Gregmy Alan Sifferman in the amount of 18 $380.1S for past due share of educational expenses for the period from May 2010 through September 2010. 19 3.23 Othe1· 20 The fad1er agrees to submit all medical, counseling, etc. bills to his insurance company for 21 reimbursement within 10 days ofreceipt of the billing statement, but not more frequently than 22 one time per month. TI1e father further agrees to reimburse the mother for his percentage share o all medical, counseling, prescription drug, etc. expenses each month with his child support 23 payments regardless of any future insurance rehnbursetnent. If there is a reimbursement, the parties will divide that reimbursement consistent with their percentage share of the expense that 24 they each paid to the provider. (If one party advanced I 00% of the cost of treatment, d1en that party shall receive 100% of the reimbursement.) 25 The father further ag1·ees to a modification of this child suppo
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