Fillable CHILD SUPPORT PETITION TO MODIFY Simplified Mod (Maricopa County Telecommunications)

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CHILD SUPPORT PETITION TO MODIFY Simplified Mod (Maricopa County Telecommunications)

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© Superior Court of Arizona In Maricopa County
ALL RIGHTS RESERVED
DRMSS1f – 5130 - 030220
PETITION TO MODIFY
CHILD SUPPORT
“Simplified Mod”
1
To Change An Existing Court Order
15% or more (Increase OR Decrease)
OR
To Assign or Change Responsibility for
Medical Insurance
Part 1: Filing the Court Papers
(Forms and Instructions)
© Superior Court of Arizona in Maricopa County DRMSS1k-010119
ALL RIGHTS RESERVED Page 1 of 1
LAW LIBRARY RESOURCE CENTER
Petition to modify child support – simplified process
(“Simplified Mod”)
CHECKLIST
You may use this packet if the following factors apply to your situation:
You have a Maricopa County child support order and you believe the amount you pay or
receive should be changed, AND
You have completed a “Child Support Worksheet” and the result for “Child Support
Obligation” (last line from the online version or item 35 from the paper worksheet) is
different from the amount of your current order by at least 15%, OR
You want to assign responsibility or change who is responsible for medical insurance. A
modification of the medical assignment or responsibility does not need to vary by 15% or
more from the existing child support amount.
Typically, this procedure is used when there has been a change in the income of the parent(s),
OR
There are two or more children and support is no longer owed for one child but is still owed for
others.
WARNING: If the order you want to change is not from this county, ask a lawyer about the
requirements to file your Petition (Request) with this Court.
DO NOT USE THESE FORMS:
✘ To change spousal support/maintenance (alimony);
✘ If your order is from a court outside this county (unless an attorney has advised you
to);
✘ If the amount of the change in the order is not at least 15%;
✘ If the reason you are requesting the change is because the living arrangements of the
child(ren) have changed but the court order about legal decision making (custody) and
visitation has not.
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 Law Library Resource Center website.
© Superior Court of Arizona in Maricopa County Page 1 of 1 DRMSS1t-080219
ALL RIGHTS RESERVED
Law Library Resource Center
Petition to modify a court order for child support
Simplified Process
PART 1: Filing the court papers
This packet contains court forms and instructions to file a “Petition to Modify Child Support -Simplified
Process.” 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 Number
Title
# Pages
1
DRMSS1k
Checklist: You may use these forms if . . .
1
2
DRMSS1t
Table of Contents (this page)
1
3
DRMSS10i
Notice to Person Filing
1
4
DRMSS11i
Instructions: How to Complete the “Petition to Modify Child
Support – Simplified Process”
2
Use the FREE Online Child Support Calculator to produce the
Child Support Worksheet that must accompany this Petition.
For more information, see DRS12h
5
DRS12h
How to complete a “Child Support Worksheet “
1
6
DRMSS11p
Procedures: What to do After You Have completed the
“Petition to Modify Child Support”
3
DRS81i
Instructions to Complete “Child Support Order”
1
DRMSS11f
Petition to Modify Child Support - Simplified Process
3
DRS81f
Child Support Order
7
DRS88f
Current Employer Information Sheet
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 Arizona in Maricopa County DRMSS10i 010119
ALL RIGHTS RESERVED Use only most current version
Page 1 of 1
Law Library Resource Center
Simplified Modification
Notice to the Person Filing
Before your Petition can be processed, it is your responsibility to provide proof of service to the
Family Department, that the other party received a copy of your petition and papers.
If you use a process server or the Sheriff’s Office they will file the AFFIDAVIT OF SERVICE at
the Clerk of Superior Court Filing Counter and provide you with a date-stamped copy.
If the other party signs the ACCEPTANCE of SERVICE or if you serve the other party by U.S.
Mail or commercial delivery service (such as FedEx, DHL, etc), you must file at the Clerk of
Superior Court Filing Counter the:
“Acceptance of Service,” or
“Affidavit of Service with Signature Confirmation” along with a copy or printout of the
other party’s signature acknowledging receipt of delivery, or if by Certified Mail, the
green return-receipt card.
If the other party is NOT served with a copy of the Petition to Modify Child Support within
120 days, the Court will send a Notice of Dismissal.
If no proof of service is received by the Court, the request will be dismissed without
further notice 180 days after filing.
If a hearing is requested, you will be notified by mail.
© Superior Court of Arizona in Maricopa County Page 1 of 2 DRMSS11i-010119
ALL RIGHTS RESERVED
Law Library Resource Center
Instructions to Complete a “Petition to Modify Child Support - Simplified
Process”
YOU WILL NEED:
A copy of your current Child Support Order.
A copy of the current Income Withholding Order for this case, if there is one.
A completed “Child Support Worksheet” (See separate instructions for the Worksheet)
Match each numbered item in the instructions with the same numbered item (in parentheses) on the form. Type or
print neatly using black ink only.
A. Fill in the information requested at top left for the person who is filing this form. Write the ATLAS number if
one has been assigned to your case. (The spaces marked “representing” and “state bar number” are used
only if an attorney is preparing this form.)
B. Fill in the names of the persons shown as the “Petitioner / Party A” and the “Respondent / Party” on the child
support order.
C. Fill in the case number that appears on your Maricopa County order for child support.
1. Check the box to indicate whether you are Parte A or Party B, and
Fill in the date on which the Judge signed your current child support order.
Fill in the name of the Judge who signed your current child support order.
Fill in name of the court (example: “Superior Court”)
Fill in name of the county where the order was issued.
2. Check the boxes to indicate who, under the current child support order, is responsible for insurance.
3. (a) Fill in the name of the person ordered to make child support payments.
(b) Fill in the amount, schedule (monthly, weekly, bi-weekly), and payment due date listed on the current
child support order. (EXAMPLE: $150 per month payable on the 1st day of the month or $150 per month
payable one-half on the first and one-half on the 15th of the month).
4. Fill in the amount from of your completed “Child Support Worksheet”
5. To use the “simplified” process, the calculations must show you are entitled to a change of at least 15%. To
calculate the percentage of change between your current support amount and the amount calculated on your
new Child Support Worksheet, you will need to:
Calculate the amount for (a) (See next page for assistance.)
Enter the amount of child support currently ordered for (b)
Divide the amount listed in (a) by the amount listed in (b), and enter the resulting number in (c).
© Superior Court of Arizona in Maricopa County Page 2 of 2 DRMSS11i-010119
ALL RIGHTS RESERVED
See the information and step-by-step procedures on next page for assistance with 5(a)(b)(c).
5(a) is the difference between the amount of child support ordered and the amount you are requesting.
Enter the amount of child support on the current order (same as 3(a) on the Petition) $ __________
Enter amount from line 35 of the new Parents Worksheet (same as (4) on the Petition) $ __________
Which is larger? Write the larger amount here:
Write the smaller amount here: -
and SUBTRACT the smaller from the larger
Write the result in the box here and on line 5(a) :
5(b) is the amount of child support in the current order (the same as 3(b) on the Petition). Write that amount
on the line for 5(b).
5(c) is the difference between the amount currently ordered and the new amount requested (the amount you
just calculated for 5(a)), divided by the amount currently ordered, written as a percentage.
Divided 5(a) by 5(b). Write the resulting percentage on the line for 5(c).
For example, if 5(a) is $45 and 5(b) is $225.
To get (c), you would divide 45 by 225, which would equal .2 or 20%
Shown another way, that’s 45 / 225 or 45 225, which equals .2 or 20%
6. If the State of Arizona is involved in your case because you or the other party received services from the
State (DES or DCSE), mark the box for "Yes." Otherwise, mark the box for "No."
If the answer is “Yes,” you will need to provide notice of this request to change the amount of child support to the
Office of the Attorney General. Refer to page 2 of the “Procedures” document in the instruction packet for
information on providing notice to the State.
7. If there is a current Income Withholding Order for child support, fill in the date of that order. If the amount
withheld includes Court ordered payments in addition to current child support, list those other amounts
included on the Income Withholding Order.
RELIEF REQUESTED
A. Write in the same amount as you previously entered on line 4.
B. Check the boxes to indicate any requested changes in which parent is responsible for insurance, and
then write in the percentages to indicate how any uninsured medical expenses should be shared.
C. Requires no action on your part though you may strike it if you disagree.
OATH OR AFFIRMATION
Date and sign the Petition in the presence of a Clerk of Superior Court or a Notary Public. By signing, you are
stating to the Court that the information you have provided is true and correct, under penalty of perjury.
© 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 Page 1 of 3 DRMSS11p-010119
ALL RIGHTS RESERVED
Law Library Resource Center
Procedures: What to do after you have completed the “Petition to
modify child support” (simplified process)
STEP 1 Make three (3) copies* (4, if DES or DCSE is involved) of the:
Petition to Modify Child Support - Simplified Process
Child Support Worksheet
Child Support Order
Current Employer Information Sheet
* If DES or DCSS is involved, you will also need an extra copy of the Petition and the
Worksheet to serve on the State, as described in STEP 5 on next page.
STEP 2 Separate your papers into 3 sets* (4, if DES or DCSE is involved).
Set 1 for the Clerk of Superior Court:
“Petition to Modify” (original + 1 copy)
“Child Support Worksheet” (original)
“Child Support Order” (original + 2 copies)
“Current Employer Information Sheet” (original)
Set 2: Your Copy:
“Petition to Modify” (copy)
“Child Support Worksheet” (copy)
Two Self-Addressed Stamped Envelopes:
1 addressed to YOU, and
1 addressed to the other party so the Court
can mail the decision
Set 3: Other Party’s Copy:
“Petition to Modify” (copy for process server)
“Child Support Worksheet” (copy for process
server)
* Set 4 – to Serve on the State if DES or DCSS is involved.
“Petition to Modify” (copy)
“Child Support Worksheet” (copy)
“Acceptance of Service” (original) (See Step 5 on next page for more information on serving the
State)
STEP 3. Go to the Clerk of Superior Court filing counter to file your papers. You may file your papers
from 8am to 5pm, Monday through Friday, at the following Superior Court locations:
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 40th Street
Phoenix, Arizona 85032
Hand the originals and all sets of copies to the Clerk at the filing counter and pay the filing fee. The
Clerk will keep the originals, stamp the extra copies to show that these are copies of papers you
have filed with the Court, and return the stamped copies to you. The stamped sets of copies are
now called "conformed" copies.
© Superior Court of Arizona in Maricopa County Page 2 of 3 DRMSS11p-010119
ALL RIGHTS RESERVED
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.
A list of current fees is available from the Law Library Resource Center website or from the Clerk of
Court’s website.
If you cannot afford the filing fee and/or the fee for having the papers served by the Sheriff or by
publication, you may request a deferral (payment plan) when you file your papers with the Clerk of
the 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 copy.
The other Party’s copy
The copy for DES/DCSS, if required
STEP 5: Serve the papers on the other party(ies). The papers may be delivered by the
Sheriff’s Department, a licensed process server, commercial delivery service or mail
by which you can obtain an original or copy of the other party’s signature confirming
delivery or by Acceptance of Service as described in the “SERVICE” packet
available from the Law Library Resource Center or the Superior Courts webpage.
The State of Arizona may be involved if any party received public assistance for the children or used
the services of the State in establishing or collecting child support. If either party already has a case
with the State (DCSS or DES) involving the same children as in this case, notice of this action must
also be given to the Attorney General’s Office.
SERVING PAPERS ON THE STATE: (if required). The Office of the Attorney General (the “AG”)
will accept service by signing an “Acceptance of Service” form and returning the form for you to file
with the Court. There are no court fees for serving the State with an Acceptance, as described
below:
(a) You may mail or personally deliver to the Office of the “AG” assigned to your case:
a copy of the “’Petition to Modify Child Support”,
a copy of the “Child Support Worksheet”,
“Acceptance of Service” AND
a self-addressed, stamped envelope (addressed back to you).
A list of addresses for the AG’s offices is available from the Law Library Resource Center or from
the Internet.
(b) There may also be a “drop-box” in the Clerk of Superior Court’s filing counter area at which you
may leave the above listed documents and the envelope for the AG. Ask the clerk at the filing
counter, or
(c) You may mail all listed documents and the envelope to:
Office of the Attorney General
Child Support Services Section
2005 N. Central Avenue – Mail Drop 7611
Phoenix, AZ 85004
Note: The State is not considered served
until the AG’s signed Acceptance of
Service is filed with the Court!
© Superior Court of Arizona in Maricopa County Page 3 of 3 DRMSS11p-010119
ALL RIGHTS RESERVED
Note: A party who is served with the papers in Arizona, whether a person or the State of Arizona (the
AG / DCSE), has 20 days from the date of service to file a request for a hearing. A party who is served
with the papers outside Arizona has 30 days from the date of service to file a request for hearing.
STEP 6: 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 requested, a hearing or a conference will be scheduled. If no party
requests a hearing, the Judge may grant or deny your request or may still schedule a hearing
to obtain further information. If a hearing is scheduled, you will receive written notice of the
date, time, and location.
If a conference and hearing have been scheduled, be sure to write down the date, time and place
of the court hearing, and attend the hearing..
Be on time
Dress neatly
Do NOT bring children to Court
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 Arizona in Maricopa County Page 1 of 3 DRMSS11f - 010119
ALL RIGHTS RESERVED
SSM
Person Filing: (A)
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
(B) Case Number: (C)
Name of Petitioner/Party A (in original case)
PETITION TO MODIFY (change)
CHILD SUPPORT
“SIMPLIFIED PROCESS”
(B)_______________________________________
Name of Respondent/Party B, (in original case)
IMPORTANT NOTICE TO PARTY NOT REQUESTING THE MODIFICATION (CHANGE).
Your support order may be modified (changed) if you do not request a hearing.
1. Party A or Party B asks this court to modify the Arizona child support order:
The Order was issued on:
(Month/Day/Year)
The Order was issued by:
(Name of Court)
Located in this County:
If the Order was not issued by the Superior Court of Arizona in this county, the case has already been
transferred to this county and has a Maricopa County case number.
2. Under the current child support order:
Party A is responsible for providing
medical dental vision care insurance
Party B is responsible for providing
medical dental vision care insurance
Neither party was ordered to provide
medical dental vision care insurance
FOR CLERK’S USE ONLY
Case No. ___________________
© Superior Court of Arizona in Maricopa County Page 2 of 3 DRMSS11f - 010119
ALL RIGHTS RESERVED
3. The child support order current ly in effect requires Party A or Party B to make payments
of (b) $ per , payable on the day of
the month.
4. Attached is a Child Support Worksheet. According to the worksheet calculations, the child support
amount should be $ per month.
5. The following calculations show that the new amount varies from the current amount of court-ordered
child support by 15% or more.
(a) divided by (b) = (c) %
a = the difference between the amount currently ordered and the amount requested;
b = the amount currently ordered; and,
c = the percentage change
6. Is the Department of Economic Security or the Division of Child Support Enforcement (DES or DCSE)
providing services to at least one of the parties? Yes No Unknown
(If YES, see instructions regarding notice to the State in the packet.)
7. Other court-ordered payments included in the current Order of Assignment dated / /
Spousal Maintenance:
$ per
Payments on Arrears:
$ per
Other:
$ per
RELIEF REQUESTED (WHAT I WANT THIS COURT TO DO):
A. I request that child support be ordered in the amount of $ per month to be paid by
Party A or Party B, and that relief requested in the Child Support Worksheet be
ordered.
B. Regarding insurance for minor children, order that:
Party A is responsible for providing medical dental vision care insurance.
Party B is responsible for providing medical dental vision care insurance.
The costs of medical/dental/vision care expenses not paid by insurance shall be shared as follows:
Party A ____________ % Party B ____________%. Request for payment or reimbursement must
be provided to the obligated parent(s) within 180 days after the services occurred. The obligated
parent must pay or make payment arrangements within 45 days after receipt of the request.
C. If this matter goes to hearing, I further request that costs and fees incurred in bringing this
action be ordered to be paid by the opposing party.
Case No. ___________________
© Superior Court of Arizona in Maricopa County Page 3 of 3 DRMSS11f - 010119
ALL RIGHTS RESERVED
UNDER OATH OR BY AFFIRMATION
I swear or affirm under penalty of perjury that the contents of this document are true and
correct to the best of my knowledge and belief.
Date
Requesting Party’s Signature
STATE OF
COUNTY OF
Subscribed and sworn to or affirmed before me this: by
(date)
.
(notary seal) Deputy Clerk or Notary Public
NOTICE TO PARTIES
If you do not agree with the modification/change in child support, you have twenty (20) days to ask
for a hearing. If service of process is made outside the State of Arizona, the parent receiving service
has 30 days in which to ask for a hearing.
Upon proof of service and if no hearing is requested within the time allowed, the court will review the
request and enter an appropriate order modifying the support award. If an error is noted, the amount
awarded may be different from the amount requested, but the modification will not be greater than the
amount requested.
In the event the court has serious concerns regarding the accuracy of the information, or if a
substantial mathematical error is found, the court may set the matter for hearing. The court will set a
hearing if requested by either party within the time allowed. No order will be modified without a hearing
if a hearing is requested. The forms necessary to request a hearing (below) may be downloaded for
free from the Law Library Resource Center (“LLRC”) webpage or purchased at any LLRC location.
Request for Hearing
Child Support Worksheet
© 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/F
SC
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
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CHILD SUPPORT PETITION TO MODIFY Simplified Mod (Maricopa County Telecommunications)

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Completed 18 October 2021

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