Fillable FM174 MOTION FOR MODIFICATION

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FM174 MOTION FOR MODIFICATION

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Select appropriate court:
(Continued on page 2)
Superior Court Family Support Magistrate Division
Provide health insurance coverage
Yes
Pay
Pay current support in the amount of:
Type of Motion to Modify
Contribute to child care
Provide HUSKY/cash medical
Pay arrearages as follows:
1. This Court issued an order dated
Pay alimony in the amount of:
Before judgment
After judgment
Judicial District of
At (Town)
Docket number
Plaintiff's name
Plaintiff's address (Number, street, city, state, zip code)
Defendant's name
Defendant's address (Number, street, city, state, zip code)
Child Support Alimony Custody Visitation
Other (Specify):
(Name)
the Plaintiff the Defendant a Support Enforcement Officer
(Name)
(Number, street, city, state, zip code)
$ $
$ $
Have visitation or parenting time as follows:
Primary residence of children with:
$
$
Other (Specify):
every (per) on the total arrearage owed of as of (date)
% or
every (per)% of unreimbursed medical expenses
directing
MOTION FOR MODIFICATION
JD-FM-174 Rev. 3-20
C.G.S. §§ 46b-84, 46b-86
P.B. §§ 25-26, 25-30, 25-57, 25a-18, 25a-30
every (per)
I, ,
If the court has ordered you to attach a request for leave with a motion for modification of a final
custody or visitation order, you must complete and attach a Request for Leave form (JD-FM-202) to this motion.
every (per)
I ask the Court to modify (change) the existing order or orders as follows: (Select all that apply)
a. Child Support (You must file a sworn to Financial Affidavit (JD-FM-6) at least 5 days before the hearing. You must also file a completed
Worksheet for the Connecticut Child Support and Arrearage Guidelines (CCSG-1) and an Advisement of Rights Re: Income Withholding (JD-FM-71) on
your hearing date. You may also need to file an Affidavit Concerning Children (JD-FM-164) on your hearing date.)
b. Alimony (You must file a sworn to Financial Affidavit
(JD-FM-6) at least 5 days before the hearing. You must
also file an Advisement of Rights Re: Income Withholding
(JD-FM-71) on your hearing date.)
2. You must explain briefly the facts that are the reasons why you are asking for this modification.
(Select appropriate box or boxes. Attach additional sheet or sheets, if necessary.)
3. The
4.a. I am receiving state assistance or HUSKY health insurance, or I have received it in the past.
4.b. Any child that this motion is about is receiving state assistance or HUSKY health insurance, or has received it in the past.
If you answered "Yes" to either of these questions, you must send a copy of this motion to: The Office of the Attorney General,
165 Capitol Avenue, Hartford, CT 06106. If you don't give the Attorney General's Office a copy, your motion may take longer to decide.
is a "deploying parent" of the armed forces. The facts about that deployment or mobilization are:
(Select one)
, residing at
, to:
(Complete the boxes that apply to your motion)
Since the date of the order, the circumstances in this case have changed substantially, as follows:
Order current support
Increase current support
Decrease current support
Find arrearage and order payment
Provide HUSKY/cash medical
Contribute to child care
Order immediate income withholding
Provide health insurance coverage
Other
Increase Decrease
The order for current child support is substantially different from the current child support and arrearage guidelines presumptive child
support order, as follows:
No
Have custody of the child/children: (Select one)
Joint legal custody Sole custody
defendantplaintiff
, state that:
c. Custody (You must file a sworn to Financial Affidavit (JD-FM-6) at least
5 days before the hearing. You must also file an Affidavit Concerning Children
(JD-FM-164) and a completed Worksheet for the Connecticut Child Support and
Arrearage Guidelines (CCSG-1) on your hearing date.)
Modify custody as follows:
Yes
NoYes
No
the amount of alimony to be paid.
STATE OF CONNECTICUT
SUPERIOR COURT
www.jud.ct.gov
For information on ADA accommodations,
contact a court clerk or go to: www.jud.ct.gov/ADA.
Reset Form
Print Form
JD-FM-174 (Page 2) Rev. 3-20
Fee for Motion to Modify:
Hearing to
be held at
By the Court
The court has heard this motion and orders it
Granted
Further orders (if applicable):
Order
By the Court (Judge/Family Support Magistrate/Assistant Clerk)
TO ANY PROPER OFFICER:
By the Authority of the State of Connecticut, you must serve a true and attested copy of the above Motion and Order For Hearing and
Summons on the person named below in one of the ways required by law at least 12 days before the date of the hearing, and file proof of
service with this Court at least 6 days before the hearing.
q
Order for Hearing and Summons (To be completed by Clerk or Support Enforcement Officer, if applicable)
Paid
For Court Use Only
Date Ordered
Denied and
Waived
to give notice to the opposing party of the Motion and of the time
and place where the court will hear it, by having a true and attested copy of the Motion and this Order served on the opposing party by any
proper officer at least 12 days before the date of the hearing. Proof of service must be made to this Court at least 6 days before the date
of hearing.
The Court orders that a hearing be held at the time and place shown below. The Court also orders the
Assistant Clerk/Support Enforcement Officer
Plaintiff's name Defendant's name Docket number
Plaintiff Defendant Support Enforcement Officer
Superior Court, Judicial District of Date
Court Address Room Number Time
Person to be served Address
Date signed
Certification
d. Visitation/Parenting Time
(You must file a sworn to Financial Affidavit (JD-FM-6) at least 5 days before the hearing. You must also file an Affidavit Concerning Children
(JD-FM-164) and a completed Worksheet for the Connecticut Child Support and Arrearage Guidelines (CCSG-1) on your hearing date.)
Modify visitation (parenting time) as follows:
Signed (Self-represented party or attorney)
u
*If necessary, attach additional sheet or sheets with name and address that the copy was mailed or delivered to.
Name and address of each party and attorney that copy was mailed or delivered to*
Print or type name of person signing Date signed
Signature (Self-represented party or attorney)
Print name Date signed
Address (Number, street, city, state, zip code)
Phone number
Title (If applicable)
e. Other
(Please be specific)
(date) to all attorneys and self-represented parties of record and that written consent for electronic delivery was
received from all attorneys and self-represented parties of record who received or will immediately be receiving electronic delivery.
I certify that a copy of this document was or will immediately be mailed or delivered electronically or non-electronically on
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FM174 MOTION FOR MODIFICATION

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Completed 6 April 2020

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