LEGAL GUIDE
Written by attorney Robert Walter Dapelo | May 12, 2010

QUALIFIED LIFE INSURANCE CHILD SUPPORT ORDER New York State

NOTICE: YOUR WILLFUL FAILURE TO OBEY THIS ORDER MAY, AFTER A COURT HEARING, RESULT IN YOUR COMMITMENT TO JAIL FOR A TERM NOT TO EXCEED SIX MONTHS, FOR CONTEMPT OF COURT. This Qualified Life Insurance Child Support Order, orders and directs that the unemancipated dependents names Herein: Name Date of Birth Social Security # Mailing Address The Participant (legally responsible relative) is: Name Date of Birth Social Security # &nbsp&nbsp Mailing Address ORDRED, that said coverage shall be effective as of the execution date of the parties' Stipulation of Settlement, to wit: and shall continue until the last dependent with the terms of the Stipulation of Settlement entered into between the parties on the ORDERED, that defendant shall provide plaintiff with proof of said beneficiary designations and proof than the premiums have been paid within 30 days of execution of this order and thereafter, once a year upon written request by the plaintiff, until termination as provided for herein. Dated;_ ______________________________ J.S.C.

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