Fillable INSTRUCTIONS: COLLEGE AND/OR SPECIAL MEDICAL EXPENSES Minor Child (Indiana Legal Help)

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INSTRUCTIONS: COLLEGE AND/OR SPECIAL MEDICAL EXPENSES Minor Child (Indiana Legal Help)

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Page 1 of 3 Approved by the Coalition for Court Access
CCA-DC-0519-3013
STATE OF INDIANA ) IN THE ___________________ _____________ COURT
)SS:
COUNTY OF _________________ ) CASE NO. __________________________________
IN RE THE ____________________ OF:
_______________________________
Minor Child (paternity only)
_______________________________
Petitioner,
v.
_______________________________
Respondent
APPEARANCE BY UNREPRESENTED PERSON IN CIVIL CASE
This Appearance Form must be filed on behalf of every party in a civil case.
1. My name is _________________________________ and I am:
☐ Initiating (filing)
☐ Responding (answering or defending)
☐ Intervening
in this case I am not represented by a lawyer.
2. Contact information for receiving legal service of document and case information as required by Court
Rules. (NOTE: If you are the Initiating Party and this case, or a related case, involves a protection
from abuse order, a workplace violence restraining order, or a no-contact order, you must provide an
address for the purpose of legal service of documents. But, that address should not be one that exposes
your location.)
Address:
Email address:
☐ I will accept service at the above email address.
Phone:
Fax:
--------------------------------------------------------------------------------------------------------------------------------------
INSTRUCTIONS: COLLEGE AND/OR SPECIAL MEDICAL EXPENSES
FOR THE SECTION ABOVE THE DOTTED YELLOW LINE
LOOK AT THE COURT PAPERS YOU HAVE IN THIS CASE
AND COPY THE INFORMATION HERE
YOUR NAME HERE
IF YOUR NAME IS ABOVE 'PETITIONER',
CHECK 'INITIATING' IF YOUR NAME IS
ABOVE RESPONDENT, CHECK
'RESPONDING'
YOUR ADDRESS
YOUR EMAIL
IF YOU HAVE AN EMAIL THAT YOU CHECK
EVERY DAY AND ONLY WANT THE COURT TO
SEND YOU INFORMATION VIA EMAIL, CHECK
THIS BOX
YOUR PHONE NUMBER
YOUR FAX NUMBER (IF YOU HAVE ONE)
__________________
_________________
Page 2 of 3 Approved by the Coalition for Court Access
CCA-DC-0519-3013
OR, if in a related case, you have used the Attorney General confidential address, you may check the
box below:
☐ Attorney General confidential address
3. This is a _____ case type as defined in Administrative Rule 8(B)(3).
(The Clerk will tell you the case type if you do not know it, so you may handwrite your response at the
Clerk’s Office.)
4. This case involves child support issues and the names and social security numbers of all family
members are on a separately attached document marked “Not For Public Access In Accordance With
Administrative Rule 9)
5. There are related cases: (If yes, please indicate below)
☐ Yes
☐ No
Caption and case number of related cases:
Caption: Case No.:
Caption: Case No.:
Caption: Case No.:
Additional information as required by local rule:
Signature
CERTIFICATE OF SERVICE
I hereby certify that I sent a copy of this Appearance by first class mail to the opposing party’s attorney,
or to the opposing party if the opposing party is not represented by an attorney on
______________________________.
Signature
IF YOU USE
THE ATTORNEY
GENERAL
CONFIDENTIAL
ADDRESS,
CHECK THIS
BOX
IF THERE ARE OTHER CASES RELATED TO THIS ONE, CHECK YES
AND FILL OUT THE BLANKS BELOW
IF ADDITIONAL INFORMATION IS REQUIRED BY LOCAL COURT RULE, ADD IT HERE
Page 1 of 1 Approved by the Coalition for Court Access
CCA-DC-0320-1069
www.indianalegalhelp.org
NOT FOR PUBLIC ACCESS
IN ACCORDANCE WITH INDIANA RULES ON
ACCESS TO COURT RECORDS
A
TTENTION CLERK: FOR SELF REPRESENTED LITIGANTS TREAT THIS FORM AS IF IT
IS PRINTED ON LIGHT GREEN PAPER. IF E-FILED, FILE AS A CONFIDENTIAL
DOCUMENT.
STATE OF INDIANA IN THE ____________________ ___________ COURT
COUNTY OF __________________ CAUSE NO: _____________________________
IN THE ________________OF
_______________________
Minor Child (paternity only)
_______________________
Petitioner
vs.
_______________________
Respondent
CIVIL APPEARANCE FORM
Social security numbers of all family members in cases involving child support
Name: ______________________________________SS#________________________________
Name: ______________________________________SS#________________________________
Name: ______________________________________SS#________________________________
Name: ______________________________________SS#________________________________
Name: ______________________________________SS#________________________________
Name: ______________________________________SS#________________________________
NOT FOR PUBLIC ACCESS
-----------------------------------------------------------------------------------------------------------------------------------------
FOR THE SECTION ABOVE THE DOTTED LINE, LOOK AT THE
COURT PAPERS YOU HAVE IN YOUR CASE AND COPY THE
INFORMATION HERE.
YOUR NAME YOUR SOCIAL SECURITY NUMBER
CHILD'S NAME CHILD'S SOCIAL SECURITY NUMBER
OTHER PARENT'S NAME OTHER PARENT'S SOCIAL SECURITY NUMBER
Page 1 of 2 Approved by the Coalition for Court Access
CCA-DC-0519-1019
STATE OF INDIANA ) IN THE ______________ _______________ COURT
)SS:
COUNTY OF __________________ ) CASE NO. ___________________________________
IN RE THE _________________ OF:
_______________________________
Minor Child (paternity only)
_______________________________
Petitioner,
v.
_______________________________
Respondent.
VERIFIED PETITION FOR COLLEGE EXPENSES AND/OR SPECIAL MEDICAL,
HOSPITAL OR DENTAL EXPENSES
Comes now ________________________________, self represented, and states or affirms as
follows:
1. That parties are the parents of the following children:
Name Age Date of birth
______
______
______
______
2. On or about __________________, this Court entered an Order of Support for child(ren)
in the amount of $__________________ per week.
3. At that time, the Court did not enter an Order with respect to the payment of college
expenses or special medical, hospital, or dental expenses for the child(ren) beyond the age of emancipation
of the child(ren).
4. ______________________ will be attending _________________________ as a
____________________________ student beginning ____________________.
----------------------------------------------------------------------------------------------------------------------------------
FOR THE SECTION ABOVE THE DOTTED LINE LOOK
AT THE COURT PAPERS YOU HAVE IN THIS CASE
AND COPY THE INFORMATION HERE
YOUR NAME
NAMES, AGES, AND BIRTH DATES OF THE CHILDREN YOU HAVE WITH THE OTHER PARTY
DATE OF LAST SUPPORT
ORDER
SUPPORT AMOUNT
CHILD
NAME OF SCHOOL
SELECT FULL OR PART TIME
START DATE
__________________
_________________
_______________
Page 2 of 2 Approved by the Coalition for Court Access
CCA-DC-0519-1019
5. For the year 20____/20____, the anticipated educational expenses are
_______________________ after all scholarships, grants and non-repayable financial aid is deducted.
(Note: You must provide documentation at or before the court hearing).
6. The child(ren) has/have special medical, hospital or dental expenses. Specifically:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
7. The parties are capable of paying for a portion of the reasonable educational expenses,
including tuition, room and board, transportation, fees, books and supplies, and special medical, hospital
or dental expenses.
8. My gross (before tax) weekly income is $______________ per week.
9. The ____________________ has a gross (before tax) weekly income of $______________
per week.
10. I am seeking an Order for the payment of college expenses and/or special medical, hospital
or dental expenses for the child(ren).
WHEREFORE, I request that this Court:
a. Set this matter for hearing for the purpose of determining contribution towards college
expenses, special medical, hospital, or dental expenses.
b. Direct the parties to produce proof of income, including last year’s W-2’s and tax returns
and year-to-date paystubs.
c. Enter an Order for college expenses and special medical, hospital, or dental expenses.
d. Modify the existing order of current support for the child(ren).
Grant all further and proper relief in the premises.
I affirm under the penalties of perjury that the foregoing representations are true.
____________________________________ ____________________________________
Signature Date
CERTIFICATE OF SERVICE
I hereby certify that I sent a copy of the Petition by first class mail to the opposing attorney, or
the opposing party if the opposing party is not represented by an attorney, on _____________________.
____________________________________ ____________________________________
Signature Date
SCHOOL YEAR
ANTICIPATED EXPENSES
LIST SPECIAL MEDICAL EXPENSES, IF ANY
YOUR GROSS,
WEEKLY
INCOME
OTHER PARTY'S NAME
OTHER PARTY'S
GROSS WEEKLY
INCOME
PRINT THIS DOCUMENT AND THEN SIGN AND DATE HERE
PRINT THIS DOCUMENT AND THEN SIGN AND DATE HERE
DATE YOU SEND THIS TO OTHER
PARTY
Page 1 of 1 Approved by the Coalition for Court Access
CCA-DC-0519-1020
STATE OF INDIANA ) IN THE ______________ _______________ COURT
)SS:
COUNTY OF __________________ ) CASE NO. ___________________________________
IN RE THE _________________ OF:
_______________________________
Minor Child (paternity only)
_______________________________
Petitioner,
v.
_______________________________
Respondent.
ORDER SETTING HEARING
Comes now _____________________________________, self represented, having filed a
Verified Petition For College Expenses And/Or Special Medical, Hospital or Dental Expenses, and the
Court finds that the matter should be set for hearing.
IT IS THEREFORE ORDERED that this matter shall be heard on
__________________________________________________________________________________.
____________________________________ _____________________________________
Date Judicial Officer
☐ The Clerk shall serve this pleading upon __________________________________ by
certified mail at the following address (this requires an additional fee payable to the Clerk):
____________________________________________
____________________________________________
____________________________________________
☐ The Clerk shall have this pleading served upon _____________________________ by
sheriff at the following address:
____________________________________________
____________________________________________
____________________________________________
Distribution:
___________________________________________
___________________________________________
FOR THE SECTION ABOVE THE DOTTED LINE LOOK
AT THE COURT PAPERS YOU HAVE IN THIS CASE
AND COPY THE INFORMATION HERE
-----------------------------------------------------------------------------------------------------------------------------------
YOUR NAME
LEAVE THIS BLANK
LEAVE THIS BLANK LEAVE THIS BLANK
CHECK THE BOX
THAT INDICATES HOW
YOU WANT THE OTHER
PARTY TO RECEIVE
THESE DOCUMENTS.
FEES MAY APPLY. THEN
FILL IN THE OTHER
PARY'S NAME AND
ADDRESS
PETITIONER'S NAME
RESPONDENT'S NAME
_________________
Page 1 of 3 Approved by the Coalition for Court Access
CCA-DC-0519-1021
STATE OF INDIANA ) IN THE ______________ _______________ COURT
)SS:
COUNTY OF __________________ ) CASE NO. ___________________________________
IN RE THE _________________ OF:
_______________________________
Minor Child (paternity only)
_______________________________
Petitioner,
v.
_______________________________
Respondent.
ORDER FOR COLLEGE EXPENSES AND/OR SPECIAL MEDICAL, HOSPITAL OR
DENTAL EXPENSES
Comes now ________________________________, self represented, and having filed a Verified
Petition for College Expenses And/Or Special Medical, Hospital or Dental Expenses and
______________________________, self represented and the Court having held a hearing and having
been duly advised as to the financial status of the parties, and having utilized the Indiana Child Support
Guidelines, and having evaluated the needs of the child(ren) now finds as follows:
1. That that child(ren), namely ________________________________, is required to
contribute toward post-secondary school expenses by paying the amount equivalent to $_____________
per semester. Payment shall be made in the following manner:
____________________________________________________________________________________
____________________________________________________________________________________
___________________________________________________________________________________.
2. That ______________________ is to contribute toward the post-secondary school
expenses of the child(ren), namely __________________________________, by paying the amount
equivalent to $______________________ per semester. Payment shall be made in the following manner:
FOR THE SECTION ABOVE THE DOTTED LINE LOOK
AT THE COURT PAPERS YOU HAVE IN THIS CASE
AND COPY THE INFORMATION HERE
-----------------------------------------------------------------------------------------------------------------------------------
FULL NAME
OTHER PARTY
CHILD
CHILD
FILL IN THE
HIGHLIGHTED SPACES
AND LEAVE THE
LEFT BLANK
__________________
_________________
Page 2 of 3 Approved by the Coalition for Court Access
CCA-DC-0519-1021
____________________________________________________________________________________
____________________________________________________________________________________
___________________________________________________________________________________.
3. That ______________________ is to contribute toward the post-secondary school
expenses of the child(ren), namely __________________________________, by paying the amount
equivalent to $______________________ per semester. Payment shall be made in the following manner:
____________________________________________________________________________________
____________________________________________________________________________________
___________________________________________________________________________________.
4. _________________________________ is required to maintain health insurance coverage
for the child(ren), namely _______________________________, so long as the child(ren) remains
eligible for coverage.
5. ________________________________ is required to contribute towards the special
medical, hospital, or dental expenses of the child(ren), namely __________________________, not
otherwise covered by insurance in the amount of $_________________ per year, or ________%.
6. ________________________________ is required to contribute towards the special
medical, hospital, or dental expenses of the child(ren), namely __________________________, not
otherwise covered by insurance in the amount of $_________________ per year, or ________%.
7. The existing child support obligation for the child(ren) in the amount of $___________ per
week, is terminated effective the first Friday following the date of this Order.
8. The current child support obligation for the remaining unemancipated children:
Name Date of birth
shall be $_________________ per week, effective _______________________, health insurance
coverage must be provided by _________________________________ and the custodial parent must be
responsible for the first $______________ (6%) per year of reasonable medical, dental, hospital,
pharmaceutical and optical expenses not covered by insurance, with the balance being split between the
CHILD
FILL IN THE
HIGHLIGHTED SPACES
AND LEAVE THE
LEFT BLANK
Page 3 of 3 Approved by the Coalition for Court Access
CCA-DC-0519-1021
parties, with ________________________ paying _____% and ______________________________
paying _______ %.
9. The child support arrearage, if any, due and owing to the _________________________
as of _____________________, 20____, is in the amount of $_______________. The
__________________________ must pay this amount at the rate of $_________________ per week until
the same is paid and fully satisfied.
10. All support payments shall be made through the County Clerk’s Office (cash payments
only) or the State Central Collection Unit Po box 7130, Indianapolis, Indiana 46207-7130 (any payments
other than cash). The court shall issue and immediately activate an Income Withholding Order pursuant
to IC § 31-16-15 to any employer or income provider to the child support Obligor.
SO ORDERED______________________________________________________________________
____________________________________
Judicial Officer
Distribution:
____________________________
____________________________
LEAVE BLANK
LEAVE BLANK
PETITIONER
RESPONDENT
FILL IN THE
HIGHLIGHTED SPACES
AND LEAVE THE
LEFT BLANK
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INSTRUCTIONS: COLLEGE ANDOR SPECIAL MEDICAL EXPENSES Minor Child (Indiana Legal Help)

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Completed 31 December 2021

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