Fillable AGREEMENT TO MODIFY (Maricopa County Telecommunications)

Fill Online, Printable, Fillable, Blank AGREEMENT TO MODIFY (Maricopa County Telecommunications) Form

Use Fill to complete blank online MARICOPA COUNTY TELECOMMUNICATIONS (AZ) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

AGREEMENT TO MODIFY (Maricopa County Telecommunications)

On average this form takes 62 minutes to complete

The AGREEMENT TO MODIFY (Maricopa County Telecommunications) form is 34 pages long and contains:

  • 0 signatures
  • 97 check-boxes
  • 201 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Maricopa County Telecommunications

BROWSE MARICOPA COUNTY TELECOMMUNICATIONS (AZ) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
© Superior Court of Arizona in Maricopa County
ALL RIGHTS RESERVED
DRMCS7 – 5178 – 030220
AGREEMENT
TO MODIFY
CHILD SUPPORT
1
WHEN ALL PARTIES WILL SIGN
AGREEMENT TO MODIFY
(Forms and Instructions)
© Superior Court of Arizona in Maricopa County Page 1 of 1 DRMCS7k-010119
ALL RIGHTS RESERVED
LAW LIBRARY RESOURCE CENTER
AGREEMENT TO MODIFY CHILD SUPPORT
CHECKLIST
You may use these forms if . . .
You have a current “Child Support Order” that was entered in Maricopa County,
You wish to modify the Order,
ALL parties AGREE to modify the Order,
You have the notarized signatures of all parties on the Agreement, AND
If either party is using the child support collection or enforcement services of the State,
you also have the signature of the Attorney General’s representative (from DCSE, the
Division of Child Support Enforcement).
You understand these forms do not deal with arrears (back support).
DO NOT USE THESE FORMS IF . . .
X The other party will not sign the agreement (in front of a notary or Court Clerk).
X You want to modify arrears (money owed for overdue support).
READ ME: Consulting a lawyer before filing documents with the court may help
prevent unexpected results. A list of lawyers you may hire to advise you on handling
your own case or to perform specific tasks, as well as a list of court-approved mediators
can be found on the Superio Court website.
FEE WARNING: An Agreement (or “stipulation”) is a filing by BOTH parties. If one of
the parties has not previously “made an appearance”, that is he and/or she have not
previously filed a response or other papers and paid a filing fee under this case number,
there will be a substantial appearance fee due from that party in addition to the filing
fee for the modification itself.
© Superior Court of Arizona in Maricopa County Page 1 of 1 DRMCS7t 080219
ALL RIGHTS RESERVED
Law Library Resource Center
Agreement to modify a court order for child support
This packet contains court forms and instructions to file to modify a court order for current child
support when all parties are willing to provide their notarized signatures on the Agreement. Items in
BOLD are forms that you will need to file with the Court. Non-bold items are instructions or
procedures. Do not copy or file those pages!
Order
File No.
Title
#
pages
1
DRMCS7k
Checklist: You may use these forms if . . .
1
2
DRMCS7t
1
3
DRMCS71i
1
4
DRS81i
1
You will need to use the FREE Online Child Support Calculator to produce the “Child Support Worksheet”
that must accompany this Agreement.
See the instruction document DRS12h for more information.
5
DRS12h
1
6
DRMCS71p
2
7
DRMCS71f
5
8
DRS81f
Child Support Order
7
9
DRS88f
Current Employer Information
1
10
DRSW82f
Order Stopping Income Withholding Order
1
The documents you have received are copyrighted by the Superior Court of Arizona in Maricopa
County. You have permission to use them for any lawful purpose. These forms shall not be used
to engage in the unauthorized practice of law. The Court assumes no responsibility and accepts
no liability for actions taken by users of these documents, including reliance on their contents.
The documents are under continual revision and are current only for the day they were received. It
is strongly recommended that you verify on a regular basis that you have the most current
documents.
© Superior Court of Maricopa County Page 1 of 1 DRMCS71i 010119
ALL RIGHTS RESERVED
Law Library Resource Center
Instructions: How to complete all forms needed to submit an
“Agreement to Modify Child Support”
Use the FREE online child support calculator at the Superior Court website to produce the Child Support
Worksheet that MUST be turned in along with this Agreement.
Using the online calculator is FREE (access to the Internet and a printer required).
If you do not have access to the Internet and/or a printer, you may use the computers at all Law Library
Resource Center locations and print out the Worksheet produced by the online calculator as well. There
is a small, per-page charge for printing. Online calculators are available at:
ezCourtForms https://www.superiorcourt.maricopa.gov/ezcourtforms2/
Arizona Supreme Court http://www.azcourts.gov/familylaw/Child-Support-Calculator-Information
Advantages of Using the Online Child Support Calculator
The online calculator is free.
The online calculator does the math for you
The online calculator produces a neater, more readable worksheet.
The online calculator produces a more accurate child support calculation, AND
You don’t have to go more than 35 pages of Guidelines and Instructions
If you want to perform the calculations yourself, you will need more than 35 pages of guidelines, instructions,
and the Worksheet. These are available for separate purchase from the Law Library Resource Center as
part of the “Child Support” packet, or may be downloaded for free from the Court webpage.
COMPLETE THE “AGREEMENT TO MODIFY CHILD SUPPORT”
ALL Parties Must Sign this Agreement. That means:
1. BOTH parents must sign in front of a Clerk at the Filing Counter or a Notary, and
2. If the State of Arizona (DES / DCSE) is involved, a representative of the Arizona Attorney General’s
office, DCSE, must ALSO sign before you turn in the papers.
OTHER FORMS YOU MAY NEED
Current Employer Information Sheet (CEI)
Complete a CEI for the parent who is paying child support under the current court order.
If this agreement changes which parent pays child support, include a CEI for both parents.
Order Stopping Income Withholding Order
IF the agreement results in the parent who is currently paying NO LONGER having to pay, include an
“Order Stopping Income Withholding Order” to be sent to that parent’s employer.
Child Support Order - If child support is still to be paid by either parent after this Agreement, include a new
“Child Support Order” (See separate instructions [DRS81i] in this packet).
When you have completed all needed forms, go to the “Procedures” page and follow the steps listed
there.
Law Library Resource Center
INSTRUCTIONS: HOW TO COMPLETE THE
“CHILD SUPPORT ORDER”
Type or print neatly using BLACK INK ONLY.
CASE CAPTION
• If you are providing this information to establish a child support order, fill in
the names and t he dates of birth (DOB) of the persons shown as
Petitioner / Party A and Respondent / Party B on the petition to establish child
support. Or to get other relief (divorce, paternity, etc.)
• If you are providing this information to modify your current support
order, fill in the names and dat es of birth (DOB) of the persons shown as
Petitioner/Party A and Respondent/Party B on the Order that established
the child support.
• Fill in your case number.
• Fill in your ATLAS number. I f you do not have an A TLAS number, leave this
item blank.
NUMBERED INSTRUCTION
Match the number of the instruction below to the matching number on the first page of
the “Child Support Order.”
(1) Fill in the full name of the legal parents (Party A and Party B) of the minor
children who are the subject of this “Child Support Order.”
Fill in the full name and bi rth date of all minor children who are the
subject of this “Child Support Order.” (Use extra pages if necessary).
LEAVE THE REST OF THE FORM BLANK. THE JUDGE OR COMMISSIONER WILL
COMPLETE THE REST OF THE INFORMATION AND SIGN THE ORDER.
© Superior Court of Arizona in Maricopa County DRS81i 090617
ALL RIGHTS RESERVED Page 1 of 1 Use most current version
© Superior Court of Maricopa County Page 1 of 1 DRS12h 010119
ALL RIGHTS RESERVED
Law Library Resource Center
HOW TO COMPLETE A
CHILD SUPPORT WORKSHEET
Use one of the FREE online child support calculators to produce the Child Support Worksheet
that MUST be turned in along with your other court papers.
Using the online calculators is FREE (access to the Internet and a printer required).
If you do not have access to the Internet and/or a printer, you may use the computers any Law
Library Resource Center location. There is a small, per-page charge for printing. Online
calculators are available at:
ezCourtForms https://www.superiorcourt.maricopa.gov/ezcourtforms2/
Arizona Supreme Court http://www.azcourts.gov/familylaw/Child-Support-Calculator-
Information
Advantages of Using the Online Child Support Calculator
The online calculator is free.
The online calculator does the math for you.
The online calculator produces a neater, more readable worksheet.
The online calculator produces a more accurate child support calculation,
AND
You don’t have to go through more than 35 pages of Guidelines and
Instructions
If you want to perform the calculations yourself, you will need an additional 35 or more pages of
guidelines, instructions, and the Child Support Worksheet form. These are available for separate
purchase from the Law Library Resource Center as part of the “How to Calculate Child Support”
packet, or may be downloaded for free from the Law Library Resource Center’s web page
(https://superiorcourt.maricopa.gov/llrc/family-court-forms/).
When you have completed all needed forms, go to the “Procedures” page and follow the steps.
© Superior Court of Arizona in Maricopa County DRMCS71p-010119
ALL RIGHTS RESERVED Page 1 of 2
Law Library Resource Center
Procedures: What to do after you have completed the forms to
Modify Child Support by Agreement
STEP 1: After you have completed all of these documents, make two copies of documents
numbered “1” and “2”
1. “Agreement to Modify Child Support” (“Agreement to Modify”)
2. “Child Support Worksheet”
“Current Employer Information Sheet”* (may refer to sources of money other than employers)
2
nd
“Current Employer Information Sheet”* (if applicable)*
“Order Stopping Income Withholding Order” (if applicable)*
STEP 2: Separate your documents into three sets:
Set 1 – ORIGINALS to file with Clerk
Agreement to Modify (1 original)
Child Support Worksheet
Child Support Order (if child support still to be paid)
Order Stopping Income Withholding Order* (if applicable)*
Current Employer Information
Current Employer Information* (for other parent, if applicable)*
+2 Self-Addressed, Stamped Envelopes:
One Addressed to you;
One Addressed to the Other Party
Set 2 – COPIES for Other Party
Agreement to Modify
Child Support Worksheet
Set 3 – COPIES for You
Agreement to Modify
Child Support Worksheet
* IF the agreement results in the parent who is currently paying NO LONGER having to pay, include
an “Order Stopping Income Withholding Order” to be sent to that parent’s employer.
* IF the Agreement changes which parent pays child support, include a “Current Employer Information”
sheet for that parent, the one who will now pay child support, also.
STEP 3: File the papers at the Court. Take all originals and copies.
Go to the Clerk of Superior Court’s Filing Counter: Present the originals, the envelopes and all sets of
copies to the Clerk at the filing counter. The Clerk will keep the originals and the envelopes, and stamp
the extra copies to show that these are copies of papers filed with the Court, and return the conformed
(stamped) copies to you.
You may file your papers from 8am to 5pm, Monday through Friday, at any of the following Superior
Court locations:
© Superior Court of Arizona in Maricopa County DRMCS71p-010119
ALL RIGHTS RESERVED Page 2 of 2
Central Court Building
201 West Jefferson, 1st floor
Phoenix, Arizona 85003
Southeast Court Complex
222 East Javelina Avenue, 1st floor
Mesa, Arizona 85210
Northwest Court Complex
14264 West Tierra Buena Lane
Surprise, Arizona 85374
Northeast Court Complex
18380 North 40
th
Street
Phoenix, Arizona 85032
FEES: There are fees for filing petitions, responses, requests, motions, objections, and various forms
with the Court. Cash, AMEX/VISA/MasterCard debit or credit cards, or money order made payable to
the “Clerk of Superior Court” are acceptable forms of payment.
An Agreement (or “Stipulation”) is a filing by BOTH parties. If one of the parties has not previously
“made an appearance”, that is he and/or she have not previously filed a response or other papers and
paid a filing fee under this case number, there will be a substantial appearance fee due from that party
in addition to the filing fee for the modification itself.
If you cannot afford the filing fee and/or the fee for having the papers served by the Sheriff’s Office, you
may request a deferral (payment plan) when you file your papers with the Clerk of Superior Court.
Deferral Applications are available at no charge from the Law Library Resource Center.
STEP 4: Make sure you get back the following from the Clerk:
Your sets of copies with the Clerk’s stamp on them (the “conformed” copies).
WHAT THE COURT MAY DO:
Grant the relief you requested;
Schedule a hearing for you and the other party if the Judge needs additional information;
Return your paperwork because you did not show good reason for the change requested or
the paperwork was incomplete; OR
Enter other orders the Judge thinks proper.
STEP 5: Wait for the Court to let you know whether the Order was signed or the matter was set for a
hearing. If a hearing is scheduled, you will receive written notice of when and where to
appear (date, time, and location).
REMINDER:
Did you provide two self-addressed, stamped envelopes (to the Clerk) so the staff can mail the
decision to both parties (as listed in STEP 3, above)?
one addressed to you
one addressed to the other party
© Superior Court of Arizona in Maricopa County Page 1 of 5 DRMCS71f 010119
ALL RIGHTS RESERVED
Person Filing: (1)
Address (if not protected):
City, State, Zip Code:
Telephone:
Email Address:
ATLAS Number:
Lawyer’s Bar Number:
Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent
SUPERIOR COURT OF ARIZONA
IN MARICOPA COUNTY
(2) (3) Case No.
Petitioner/Party A (in original case)
(4) ATLAS No.
(2) AGREEMENT TO MODIFY CHILD
Respondent/Party B (in original case)
SUPPORT
This is an agreement between the person who owes child support and the person to whom
child support is owed to modify (change) the amount to be paid for current child support.
We, (5a) , the person ordered to make payments,
and (5b) , the person receiving payments,
ask the Court to modify the Child Support Order as indicated below.
(6) INFORMATION ABOUT THE CURRENT CHILD SUPPORT ORDER (the Order we want to change)
The Order was issued on:
(Month/Day/Year)
The Order was issued by:
(Name of Court)
Located in this County:
(Name of County)
Amount of Current Child Support Ordered: $
PER
(7)
The current Income Withholding Order includes the following Court Ordered payments:
Child Support: $ per
Spousal Maintenance/Support: $ per
Other: $ per
Payments on Arrears: $ per
(8) We agree that current child support should be changed from the current amount of
FOR CLERK’S USE ONLY
Case No. __________________
© Superior Court of Arizona in Maricopa County Page 2 of 5 DRMCS71f 010119
ALL RIGHTS RESERVED
$ per month,
to be paid by
(as listed in (6) above), to the new amount of $
Party A or Party B.
(9) We agree this change should take effect the first day of , 20____.
Note: A completed Child Support Worksheet is required before the Court can modify child support.
I have completed a Child Support Worksheet and it is attached or filed with this Agreement
(required).
(10) (Check the box (a or b, but not both) that applies to you.)
(a) The amount of child support we have agreed to is the amount stated on the attached
Child Support Worksheet, calculated according to the Arizona Child Support Guidelines,
OR
(b) The amount of child support we have agreed to is not the amount stated on the
attached Child Support Worksheet, calculated according to the Arizona Child
Support Guidelines, but we are entitled to deviate (use a different amount) from
the Guideline amount because:
Application of the Guidelines would be inappropriate or unjust in this case, AND
Deviation from the Guidelines would be in the best interests of the children
involved, based on all relevant factors, including those specified in A.R.S. § 25-
320(D):
1. The financial resources and needs of the child.
2. The financial resources and needs of the custodial parent.
3. The standard of living the child would have enjoyed had the marriage not been
dissolved.
4. The physical and emotional condition of the child, and the child's educational needs.
5. The financial resources and needs of the non-custodial parent.
6. Excessive or abnormal expenditures, destruction, concealment or fraudulent
disposition of community, joint tenancy and other property held in common.
7. The duration of parenting time and related expenses.
Based on all relevant factors including any of those listed above that apply to our situation,
application of the Guideline amount would be inappropriate or unjust and deviation from
Case No. __________________
© Superior Court of Arizona in Maricopa County Page 3 of 5 DRMCS71f 010119
ALL RIGHTS RESERVED
the Guideline amount would be in the best interests of the children, because: (Explain)
(11) We also request that a new Income Withholding Order be issued to include the new child
support amount and any additional payments listed in (7), on page one of this Agreement.
(12) AGREEMENT REGARDING SUPPORT EXPENSES and TAX DEDUCTIONS:
Party A is responsible for providing:
medical dental vision care insurance.
Party B is responsible for providing: medical dental vision care insurance.
Non-Covered Expenses. All reasonable non-covered and/or uninsured medical, dental, vision
care, prescription and other health care charges for the minor children, including co-payments,
shall be shared as follows: Party A %, AND Party B %
(13) The costs of travel related to parenting time over 100 miles one way shall be shared as follows:
Party A % Party B %
(14) Federal tax exemption(s) for the dependent children should be allocated as follows:
Child’s Name
Date of Birth
(Month, Day, Year)
For Calendar
Party Entitled to
Deduction
Year
Party A Party B
Party A Party B
Party A Party B
Party A Party B
For years following those listed above while this Child Support Order remains in effect, the parties
shall repeat the pattern above of claiming deductions for each child.
Each year, the person obligated to make payments (the obligor) may claim these exemptions only
if he or she has paid all child support and arrears ordered for the year by December 31 of that
year.
Case No. __________________
© Superior Court of Arizona in Maricopa County Page 4 of 5 DRMCS71f 010119
ALL RIGHTS RESERVED
OTHER ORDERS:
THIS AGREEMENT IS TO MODIFY CHILD SUPPORT ALONE. ALL OTHER PRIOR ORDERS OF
THIS COURT ARE TO REMAIN IN FULL FORCE AND EFFECT.
AGREEMENT TO MODIFY (CHANGE) CHILD SUPPORT
OATH OR AFFIRMATION OF THE PARTIES
(15) By signing this Agreement, I/We:
Ask the Court to order the amount of current child support ordered paid to be changed
from $______________, to the new amount of $_________________, per month, to be paid by
Party A or Party B.
Waive the right to trial on this matter.
Acknowledge reading and understanding the terms of this agreement.
Enter this agreement voluntarily and not due to any threat of force or harm, duress, undue
influence or coercion from anyone, including the other party.
Swear or affirm the information provided is true and correct, under penalty of perjury.
Case No. __________________
© Superior Court of Arizona in Maricopa County Page 5 of 5 DRMCS71f 010119
ALL RIGHTS RESERVED
NOTE: If the State of Arizona (DES) is a party to your case, a representative of DES or its Division of Child
Support Enforcement (DCSE) must also sign this form before you file. (See Instructions)
Signature of DES / DCSE Representative
Date
SIGNATURES
Petitioner’s Signature Date
STATE OF
COUNTY OF
Subscribed and sworn to or affirmed before me this: by
(date)
.
(notary seal) Deputy Clerk or Notary Public
Respondent’s Signature Date
STATE OF
COUNTY OF
Subscribed and sworn to or affirmed before me this: by
(date)
.
(notary seal) Deputy Clerk or Notary Public
© Superior Court of Arizona in Maricopa County DRS81f-030220
ALL RIGHTS RESERVED Page 1 of 7
Person Filing:
Address (if not protected):
City, State, Zip Code:
Telephone:
Email Address:
ATLAS Number:
Lawyer’s Bar Number:
Representing Self, without a Lawyer or Attorney for Petitioner Or Respondent
SUPERIOR COURT OF ARIZONA
IN MARICOPA COUNTY
Case No.
Petitioner / Party A
ATLAS No.
Date of Birth (Month, Date, Year)
CHILD SUPPORT ORDER
Respondent / Party B
A.R.S. § 25-503
Date of Birth (Month, Date, Year)
THE COURT FINDS:
1. Party A: __________________________________________________ and
Party B:
__________________________________________________
Have a duty to support the following children:
Child(ren)’s Name(s) Date of Birth
________________________________________ ________________________
________________________________________ ________________________
________________________________________ ________________________
________________________________________ ________________________
For Clerk’s Use Only
Case Number: _____________
© Superior Court of Arizona in Maricopa County DRS81f-030220
ALL RIGHTS RESERVED
Page 2 of 7
2. Child Support Guidelines: The required financial factors and any discretionary adjustments
pursuant to the Arizona Child Support Guidelines are as set forth in the Parent’s Worksheet for Child
Support Amount, attached and incorporated by reference.
3. Child Support:
Party A Party B is ordered to pay child support in the amount of
$_____________ per month to __________________________ pursuant to the Arizona
Child Support Guidelines without deviation.
Party A Party B is obligated to pay child support to Party A
Party B in the amount of $ per month pursuant to the Arizona Child
Support Guidelines without deviation. This amount is an appropriate amount to award for
child support in this case except that the Court finds it more appropriate and just to make
a rounding adjustment to the exact guideline amount for ease of calculation to $ ______
per month.
Party A Party B is obligated to pay child support to Party A
Party B in the amount of $ per month pursuant to the Arizona Child
Support Guidelines. Application of the child support guidelines in this case is
inappropriate or unjust. The Court has considered the best interests of the child in
determining that a deviation is appropriate.
After deviation the child support order is $ per month.
Party A Party B is obligated to pay child support to Party A
Party B in the amount of $ per month pursuant to the Arizona Child
Support Guidelines. Application of the child support guidelines in this case is
inappropriate or unjust. The Court has considered the best interests of the child in
determining that a deviation is appropriate.
After deviation the child support order is $ per month. Further, the parties have
entered into a written agreement or their agreement is on the record and is free of duress
and coercion with knowledge of the amount of child support that would have been ordered
under the guidelines but for the agreement.
Reason(s) for deviation:
Case Number: _____________
© Superior Court of Arizona in Maricopa County DRS81f-030220
ALL RIGHTS RESERVED
Page 3 of 7
4. Support Arrears:
Party A Party B owes child support arrearages to Party A
Party B in the total amount of $ _______ for the time period of
through plus
accrued interest on prior child support arrearages due of $ calculated
through the date of .
The Court finds no child support arrearages due and owing.
No evidence was presented in support of child support arrearages.
5. Past Support:
It is appropriate to award Party A Party B an additional judgment for past
support in the amount of $ for the period between the filing of this current
petition and the date current child support is ordered to begin.
Temporary support or voluntary / direct support payments in the amount of $
were paid during the period above; therefore, the past support is adjusted
to $ .
It is appropriate to award Party A Party B an additional judgment in the amount
of $ for past support owed from the date of separation, but not more than three
years before the date of filing the current petition.
Temporary support or voluntary / direct support payments in the amount of
$ were paid during the period above; therefore, the past support is
adjusted to $ .
The Court finds no past support amount due and owing.
No evidence was presented in support of past child support.
The Court finds no temporary support or voluntary / direct support payments were paid.
No evidence was presented in support temporary support or voluntary / direct support
payments.
6. Interest:
The Court finds interest in the amount of $ _________________________ due to
Party A Party B
For the period of: _______________________ to ____________________________.
Case Number: _____________
© Superior Court of Arizona in Maricopa County DRS81f-030220
ALL RIGHTS RESERVED
Page 4 of 7
It is ordered that:
1. Child Support Judgment:
Party A Party B shall pay child support to _____________________ in the amount of $
______________
per month. This monthly amount, payable by income withholding order, shall be
paid on the 1
st
day of each month beginning ________________.
2. Support Arrearages Judgment:
Party A Party B is granted judgment against _________________________ in the amount of
$
____________________ as and for child support arrearages for the period of __________________
through the date of __________________ together with interest on said amount at the legal rate of
10% per annum until paid in full, plus additional accrued interest on prior child support judgments
of $
________________ calculated through the date of __________________________.
Party A Party B shall pay, in addition to his OR her current support
payment, the amount of $
_________________________ per month toward this judgment, payable
on the first day of each month, beginning
_________________________ until paid in full.
NO Judgment for child support arrearages is entered.
3. Past Support Judgment:
Party A Party B is granted a past support judgment against Party A Party B in
the additional amount of $
________________. Party A Party B shall pay the additional
amount of $
___________________ per month toward this judgment, payable on the first day of each
month commencing
________________________until paid in full.
OR
NO Judgment for past support is entered.
4. Payments and Clearinghouse: All payments, plus the statutory handling fee, shall be made
through the Support Payment Clearinghouse pursuant to an Order of Assignment, or “Income
Withholding Order” signed this date. Any time the full amount of support ordered is not withheld, the
person obligated to pay (the obligor) remains responsible for the full monthly amount ordered.
Payments not made directly through the Support Payment Clearinghouse shall be considered gifts
unless otherwise ordered. All payments shall be made payable to and mailed directly to:
Support Payment Clearinghouse
P.O. Box 52107
Phoenix, AZ 85072-2107
Case Number: _____________
© Superior Court of Arizona in Maricopa County DRS81f-030220
ALL RIGHTS RESERVED
Page 5 of 7
Payments must include Party A’s or Party B’s name, and Atlas number. Pursuant to
A.R.S. § 25-322, the parties shall submit current address information in writing to the Clerk of
Superior Court and the Support Payment Clearinghouse immediately. The obligor (party being
ordered to pay) shall submit the names and addresses of his or her employers or other payors within
10 days. Both parties shall submit address changes within 10 days of the change.
5. Total Monthly Payments:
Party A Party B shall make total monthly payments to Party A Party B in the
amount of $
________________ per month, payable on the first day of each month, beginning
________________________as follows:
Monthly Payments:
Current child support payment as ordered above: $
_________________
Current spousal maintenance payment: $
_________________
Support arrearage payment: $
_________________
Clearinghouse handling fee: $ ____________ 8.00
Total monthly payment: $ _________________
6. Medical, Dental, Vision Care Insurance for Minor Children:
Party A OR Party B is responsible for providing medical dental
vision care insurance for the minor child(ren) and shall continue to pay premiums for any medical,
dental and vision policies covering the child(ren) that are currently included in the incorporated
Parent’s Worksheet for Child Support.
OR
Party A OR Party B shall be individually responsible for providing medical
insurance for the minor child(ren) of the parties as soon as it becomes accessible and
available at a r easonable cost, as neither party currently has the ability to obtain such
medical insurance.
Medical, dental, and vision insurance, payments and expenses are based on the information in the
Parent’s Worksheet for Child Support attached hereto and incorporated by reference.
The party ordered to pay must keep the other party informed of the insurance company name,
address and telephone number, and must give the other party the documents necessary to submit
insurance claims. An insurance card must be provided to the other party. Notification must also be
provided to the other party if coverage is no longer being provided for the child(ren).
7. Non-Covered Medical Expenses:
Party A is ordered to pay _______ % and Party B is ordered to pay _______ % of all reasonable
uncovered and/or uninsured medical, dental, vision, prescription and other health care charges for
the minor child(ren).
• A request for payment or reimbursement of uninsured medical, dental and/or vision costs must
be provided to the other party within 180 days after the date the services occur.
Case Number: _____________
© Superior Court of Arizona in Maricopa County DRS81f-030220
ALL RIGHTS RESERVED
Page 6 of 7
• The party responsible for payment or reimbursement must pay their share, as ordered by the
Court, or make acceptable payment arrangements with the provider or person entitled to
reimbursement within 45 days after receipt of the request.
8. Travel expenses: The costs of travel related to parenting time over 100 miles one way shall be
shared as follows: Party A
____________ % Party B ____________%
9. Information exchange: The parties shall exchange financial information such as copies of tax
returns, financial affidavits, and earnings statements every twenty-four months. At the time the
parties exchange financial information, they shall also exchange residential addresses and the
names and addresses of their employers unless the Court has ordered otherwise.
10. Tax exemptions: The Court allocates the following federal tax exemption(s) for the dependent
child(ren):
Child’s Name
Date of Birth
(Month, Day, Year)
Parent Entitled For Calendar
to Deduction Year
Party A Party B
Party A Party B
Party A Party B
Party A Party B
For years following those listed above while this Child Support Order remains in effect, the parties shall
repeat the pattern above of claiming deductions for each child.
Party A or Party B may claim the allocated tax exemptions only if all support and arrears
ordered for the year have been paid by December 31 of that year. An Internal Revenue Service form
8332 may need to be signed and filed with a party’s income tax return. See IRS Form 8332 for more
detailed information.
Party A or Party B may unconditionally claim the tax exemption allocated to Party A or
Party B for income tax purposes. An Internal Revenue Service Form 8332 may need to be signed
and filed with a party’s income tax return.
See IRS Form 8332 for more detailed information.
Even though the court’s judgment contains orders regarding medical insurance and the allocation of
the right to claim the child as a dependent for the purposes of federal taxes, these orders are not
binding on the IRS. Under the Affordable Care Act, the party who claims a child as a dependent on
a federal tax return has the obligation to ensure that the child is covered by medical insurance and
may be penalized by the IRS for failing to do so. This penalty may be imposed even if it is the other
party’s responsibility to carry medical insurance on t he child under the Decree of Dissolution of
Marriage.
11. Modification: If this is a modification of child support, all other prior orders of this Court not modified
remain in full force and effect.
Case Number: _____________
© Superior Court of Arizona in Maricopa County DRS81f-030220
ALL RIGHTS RESERVED
Page 7 of 7
12. Emancipation: A child is emancipated:
• On the child’s 18
th
birthday, however if a child is still attending high school or a certified high
school equivalency program, support will continue until graduation of the child reaches 19 years
of age.
• On the date of the child’s marriage.
• When the child is adopted.
• When the child dies.
13. Other findings and orders:
14. Final Appealable Order. No further claims or issues remain for the Court to decide. Therefore, IT IS
FURTHER ORDERED pursuant to Rule 78(c), Arizona Rules of Family Law Procedure, this final
judgment/decree is signed by the Court and it shall be entered by the Clerk of Superior Court. The time for
appeal begins upon entry of this judgment by the Clerk of Superior Court. For more information on appeals,
see Rule 8 and other Arizona Rules of Civil Appellate Procedure. IT IS FURTHER ORDERED denying any
affirmative relief sought before the date of this Order that is not expressly granted above.
Date
Judicial Officer
15. Stipulation. Signature by both Parties (if applicable):
Party A Party B, by signing this document, we state to the Court under penalty of perjury
that we read and agree to this Court Order, and that all the information contained in it is true, correct,
and complete to the best of our knowledge and belief.
_______________________________ _______________________
Party A’s Signature Date
_______________________________ _______________________
Party B’s Signature Date
If either party is represented by a lawyer, the lawyer must sign below:
_______________________________ _______________________
Party A’s Lawyer Signature Date
_______________________________ _______________________
Party B’s Lawyer Signature Date
CURRENT EMPLOYER* INFORMATION
You may also fill out this form online at the Family Support Center Website.
THIS FORM MUST BE COMPLETED FOR:
AN INCOME WITHHOLDING ORDER
ORDER TO STOP AN INCOME WITHHOLDING ORDER
NOTIFICATION OF A CHANGE OF EMPLOYER (or OTHER PAYOR)
CASE NUMBER: ATLAS NUMBER:
NAME OF PERSON ORDERED TO MAKE PAYMENTS:
LIST THE NAME OF THE EMPLOYER* AND THE ADDRESS OF THE PAYROLL OR FINANCIAL
DEPARTMENT (for the person named above) WHERE THE INCOME WITHHOLDING ORDER OR
STOP ORDER SHOULD BE MAILED.
EMPLOYER* NAME:
PAYROLL ADDRESS:
CITY: STATE: ZIP:
EMPLOYER* TELEPHONE:
EMPLOYER* FAX:
*or other payor or source of funds
FOR COURT USE ONLY. DO NOT WRITE BELOW THIS LINE.
WA/FSC
For Clerk’s Use Only
WA/LOG ID:
TYPE OF W/A
DATE
AMOUNT OF ORDER
EMPLOYER STATUS
ENTERED BY
NEW W/A
SUB
AG
DCSE
SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY DRS88f-041712
All Rights Reserved Page 1 of 1
CEI
Person Filing:
Address (if not protected):
City, State, Zip Code:
Telephone:
Email Address:
ATLAS Number:
Lawyer’s Bar Number:
Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent
SUPERIOR COURT OF ARIZONA
IN MARICOPA COUNTY
(1)
(3) Case No.
Petitioner in Original Case
(2)
Respondent in Original Case
ORDER STOPPING INCOME WITHHOLDING
ORDER (AND ALL MARICOPA COUNTY SUPPORT
ORDERS)
A.R.S. § 25-504
To the employer(s) or other payor(s) of:
(5) Name of Employee:
IT IS ORDERED stopping the Income Withholding Order dated (6) , with the
same case number as in (3) above. The employer(s) or other payor(s) is/are ordered to stop
withholding monies pursuant to the Income Withholding Order immediately upon receipt of this
Order.
IT IS FURTHER ORDERED terminating all Maricopa County child support and/or
spousal maintenance orders in this case number and declaring all child support and/or spousal
maintenance orders fully paid and satisfied, including all past due support, arrearage judgments
and interest.
IT IS FURTHER ORDERED that the Support Payment Clearinghouse shall release any
monies currently in its possession and future monies received to the person ordered to pay, less
any fees owed to the Clearinghouse.
Dated:
Judicial Officer
FOR CLERK’S USE ONLY
(4) ATLAS No.
DO NOT WRITE BELOW THIS LINE. COURT PERSONNEL WILL COMPLETE THE FORM.
© Superior Court of Arizona in Maricopa County DRSW82f- 092017
ALL RIGHTS RESERVED Page 1 of 1
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

AGREEMENT TO MODIFY (Maricopa County Telecommunications)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 1 August 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document