Fill - Free fillable INSTRUCTIONS: MODIFY CHILD SUPPORT WITH AGREEMENT Minor Child (Indiana Legal Help) PDF form

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,

_______________________________

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:

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INSTRUCTIONS: MODIFY CHILD SUPPORT WITH AGREEMENT

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)

PRINT FORMS

CLEAR FORMS

_______________________

_____________________

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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.:

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

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www.indianalegalhelp.org

NOT FOR PUBLIC ACCESS

IN ACCORDANCE WITH INDIANA RULES ON

ACCESS TO COURT RECORDS

ATTENTI

ON 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#________________________________

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

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CCA-DC-0519-1001

STATE OF INDIANA )

)SS:

COUNTY OF __________________ )

IN THE ______________ _______________ COURT

CAUSE NO. ___________________________________

IN RE THE _________________ OF:

_______________________________

Minor Child (paternity only)

_______________________________

Petitioner,

_______________________________

Respondent.

JOINT VERIFIED PETITION FOR MODIFICATION OF CHILD SUPPORT

1. That parties have ______ minor child(ren), namely:

Name Date of birth

2. ____________________________________ is ordered to pay $______________

in current child support effective on __________________.

3. Since that time, there has been a change in circumstances that makes the current

order vary more than 20% from what the child support guidelines would indicate should be paid,

or so substantial and continuing as to make the terms of the current support order unreasonable for

the following reasons:

INSTRUCTIONS: MODIFY CHILD SUPPORT WITH AGREEMENT

------------------------------------------------------------------------------------------------------------------------------------

FOR THE SECTION ABOVE THE DOTTED LINE, LOOK

AT THE COURT PAPERS YOU HAVE FROM THIS CASE

AND COPY THE INFORMATION HERE

Modification of Child Support, and states as follows:

INSERT THE NUMBER

OF MINOR CHILDREN

YOU AND THE

OTHER PARENT

HAVE TOGETHER

AND THEN FILL IN

THEIR NAMES AND

DATES OF BIRTH

NAME OF PERSON THAT IS

ORDERERD TO PAY CHILD SUPPORT

AMOUNT OF CHILD SUPPORT

ORDERED

DATE CURRENT CHILD SUPPORT

BECAME EFFECTIVE

Comes now NAME OF PETITIONER, self represented, and

_NAME OF RESPONDENT_, self represented, and hereby file a Joint Verified Petition For

NUMBER OF MINOR CHILDREN YOU HAVE

WITH THE OTHER PARENT

_______________________

_____________________

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________________________________________________________________________

4. Child support should be modified to reflect the substantial change in

circumstances

as outlined above.

5. We have reached an agreement on child support modification and an Agreed Entry

For Modification Of Child Support is filed with this petition.

WHEREFORE,_________________________and ______________________________

request that this Court modify the existing support as is appropriate and order all other further

relief that is just and proper in the premises.

I affirm under the penalties of perjury that the foregoing representations are true.

___________________________________ ____________________________________

Signature Date

STATE OF INDIANA )

)SS:

COUNTY OF__________________ )

Before me, ___________________________a notary public in and for _____________________

County, State of Indiana, personally appeared ___________________________________, and

he/she having been first duly sworn upon his/her oath, says that the facts all alleged in the foregoing

instrument are true.

Date _____________________________ __________________________________________

Notary Public

My Commission Expires: ___________________________

FILL IN THE REASON YOU BELIEVE CHILD SUPPORT SHOULD BE CHANGED

NAME OF PETITIONER

NAME OF RESPONDENT

AFTER YOU PRINT THIS FORM YOU MUST SIGN AND DATE IN FRONT OF A NOTARY PUBLIC

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___________________________________ ____________________________________

Signature Date

STATE OF INDIANA )

)SS:

COUNTY OF__________________ )

Before me, ___________________________a notary public in and for _____________________

County, State of Indiana, personally appeared ___________________________________, and

he/she having been first duly sworn upon his/her oath, says that the facts all alleged in the foregoing

instrument are true.

Date _________________________ __________________________________________

Notary Public

My Commission Expires: ___________________________

I affirm under the penalties of perjury that the foregoing representations are true.

AFTER YOU PRINT THIS FORM THE OTHER PARTYMUST SIGN AND DATE IN FRONT OF A

NOTARY PUBLIC

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STATE OF INDIANA ) IN THE ______________ _______________ COURT

)SS:

COUNTY OF __________________ ) CASE NO. ___________________________________

IN RE THE _________________ OF:

_______________________________

Minor Child (paternity only)

_______________________________

Petitioner,

_______________________________

Respondent.

AGREED ENTRY FOR MODIFICATION OF CHILD SUPPORT

Comes now _______________________, self represented, and

__________________________, self represented, and submit the following terms as evidence of

their agreement in this matter:

1. That the parties have ______ minor child(ren), namely:

Name Date of birth

2. ____________________________________ is ordered to pay $______________

in current child support to _____________________________effective on __________________.

3. Since that time, there has been a change in circumstances that makes the current

order vary more than 20% from what the child support guidelines would indicate should be paid,

or so substantial and continuing as to make the terms of the current support order unreasonable.

4. Child support should be modified to reflect the substantial change in circumstances.

5. ____________________________________ shall now pay child support in the

amount of $___________________ per week to __________________________, effective on

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FOR THE SECTION ABOVE THE DOTTED LINE LOOK

AT THE OTHER COURT PAPERS YOU HAVE IN THIS

CASE AND COPY THE INFORMATION HERE

NAME OF PETITIONER

NAME OF RESPONDENT

INSERT THE NUMBER OF

CHILDREN YOU AND

THE OTHER PARTY

HAVE TOGETHER AND

THEN FILL IN THEIR

NAMES AND DATES OF

BIRTH

NAME OF PERSON THAT IS ORDERED TO PAY CHILD

SUPPORT

AMOUNT OF CHILD SUPPORT

ORDERED

PERSON WHO RECEIVES CHILD

SUPPORT

DATE CURRENT CHILD SUPPORT

TOOK EFFECT

NAME OF PERSON WHO SHOULD NOW

BE ORDERED TO PAY CHILD SUPPORT

AMOUNT OF NEW

SUPPORT

PERSON WHO SHOULD NOW RECEIVE

CHILD SUPPORT

NUMBER OF MINOR CHILDREN YOU

HAVE WITH THE OTHER PARENT

_______________________

_____________________

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_________________________. (Choose an effective date between the date you filed your petition

and the date you are filing this Agreed Entry with the Court.)

6. 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.

7. Arrearages are not determined at this time and are reserved for a later date.

☐_____________________________ shall maintain medical, dental and optical

insurance as available through employment, or Health Insurance Marketplace, or by government

provided insurance for the minor child(ren).

-OR-

☐ Health insurance for the child(ren) is not available to either parent at a

reasonable cost, therefore neither party is ordered to provide health insurance at this time. In the

event that health insurance for the child(ren) becomes available at a reasonably cost to one or

both of the parties, the party to whom such coverage is available shall obtain coverage for the

children within a reasonable time after such coverage becomes available.

9. ________________________________ will be responsible for the first

$_______________ per year of uninsured health and medical, dental, optical, hospital

and prescription expenses for the minor child(ren). Thereafter, Petitioner shall be

responsible for ____% of annual uninsured health and medical, dental, optical hospital and

prescription expenses for minor child(ren), and Respondent shall be responsible for ____% of

annual uninsured health and medical, dental, optical hospital and prescription expenses for minor

child(ren).

10.

☐_____________________________ shall be entitled to claim the minor

child(ren) for federal, state, and local income tax purposes on an annual basis. The parties shall

cooperate to sign all necessary documents that will allow the party claiming the exemption to do

so.

The non-custodial parent’s right to this exemption is conditioned on them being 95%

compliant in their support by January 31 of their tax year pursuant to IC § 31-16-6-1.5(d). The

DATE NEW SUPPORT SHOULD

BE EFFECTIVE

PARAGRAPH

#8,

SELECT ONLY

ONE OF THE

BOXES. IF

ONE PARTY

WILL

MAINTAIN

INSURANCE

FOR THE

CHILDREN,

CHECK THE

FIRST BOX

AND FILL IN

THAT PARTY'S

NAME. IF

INSURANCE IS

NOT

AVAILABLE,

CHECK THE

SECOND BOX.

NAME OF PERSON WHO GETS CHILD SUPPORT

LOOK AT THE

CHILD

SUPPORT

WORKSHEET,

THERE IS AN

AMOUNT ON

LINE A

UNDER

UNINSURED

HEALTH

CARE

EXPENSES.

PUT THAT

AMOUNT

HERE.

FROM LINE

OF THE

CHILD

SUPPORT

WORKSHEET

IF YOU AGREE THAT ONLY ONE PARENT CAN

CLAIM THE CHILDREN FOR TAX PURPOSES,

CHECK THIS BOX AND PUT THAT PARENT'S

NAME HERE.

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custodial parent shall take all actions necessary to release their claim to the exemption in the

manner required under Sect

ion 152(e) of the Internal Revenue Code.

-OR-

☐Petitioner and Respondent shall each be entitled to claim the minor child(ren)

for federal, state and local income tax purposes in alternating years. Petitioner shall be entitled to

claim the minor child(ren) in the year __________, and every ______ year thereafter. Respondent

shall be entitled to claim the minor child(ren) in the year ________ and every ________ year

thereafter. The parties shall cooperate to sign all necessary documents that will allow the party

claiming the exemption to do so.

The non-custodial parent’s right to this exemption is conditioned on them being 95%

compliant in their support by January 31 of their tax year pursuant to I § 31-16-6-1.5(d). The

custodial parent shall take all actions necessary to release their claim to the exemption in the

manner required under Section 152(e) of the Internal Revenue Code.

11. Parties waive their right to a hearing.

WHEREFORE,_____________________________ and __________________________

request that this Court modify the existing child support obligation and order all further relief

that is just and proper in the premises.

I affirm under the penalties of perjury that the foregoing representations are true.

___________________________________ ____________________________________

Signature Date

STATE OF INDIANA )

)SS:

COUNTY OF__________________ )

Before me, ___________________________a notary public in and for

__________________________County, State of Indiana, personally appeared

___________________________________, and he/she having been first duly sworn upon his/her

oath, says that the facts all alleged in the foregoing instrument are true.

Date _____________________________ __________________________________________

Notary Public

My Commission Expires: ___________________________

IF YOU

AGREE THAT

EACH

PARENT

SHOULD BE

ABLE TO

CLAIM THE

CHILDREN

FOR TAX

PURPOSES

EVERY

OTHER YEAR,

CHECK THIS

BOX AND

FILL IN THE

YEAR AND

THEN SELECT

'EVEN' OR

'ODD'.

PETITIONER'S NAME

RESPONDENT'S NAME

AFTER YOU PRINT THIS FORM, YOU MUST SIGN AND DATE IN FRONT OF A NOTARY

_____________

_______________

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I affirm under the penalties of perjury that the foregoing representations are true.

___________________________________ ____________________________________

Signature Date

STATE OF INDIANA )

)SS:

COUNTY OF__________________ )

Before me, ___________________________a notary public in and for

__________________________County, State of Indiana, personally appeared

___________________________________, and he/she having been first duly sworn upon his/her

oath, says that the facts all alleged in the foregoing instrument are true.

Date _____________________________ __________________________________________

Notary Public

My Commission Expires: ___________________________

AFTER YOU PRINT THIS FORM THE OTHER PARTY MUST SIGN AND DATE IN FRONT OF

A NOTARY

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STATE OF INDIANA ) IN THE ___________________ _____________ COURT

)SS:

COUNTY OF _________________ ) CASE NO. __________________________________

IN RE THE ____________________ OF:

_______________________________

Minor Child (paternity only)

_______________________________

Petitioner,

_______________________________

Respondent

ORDER FOR MODIFICATION OF CHILD SUPPORT

Comes now, ________________________, self represented, and

_______________________, self represented, having filed an Agreed Entry For Modification Of

Child Support and the Court having been duly advised in the premises, now finds that there has

been a change in circumstances so substantial and continuing as to make the terms of the current

child support order unreasonable, and that the child support order should be modified to reflect the

substantial change in circumstances.

IT IS THEREFORE ORDERED that:

1. ____________________________________ is to pay child support to

__________________________________in the amount of $___________________ per week,

effective on _________________________.

3. 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.

4. Arrearages are not determined at this time and are reserved for a later date.

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FOR THE SECTION ABOVE THE DOTTED LINE, LOOK

AT THE OTHER COURT PAPERS YOU HAVE IN THIS

CASE AND COPY THE INFORMATION HERE.

PETITIONER'S NAME

RESPONDENT'S NAME

NAME OF PERSON ORDERED TO PAY CHILD SUPPORT

PERSON TO RECEIVE CHILD SUPPORT NEW AMOUNT ORDERED

DATE NEW SUPPORT SHOULD BE EFFECTIVE

_______________________

_____________________

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5. ☐_____________________________ shall maintain medical, dental and optical