Fillable INSTRUCTIONS: MODIFY CHILD SUPPORT WITH AGREEMENT Minor Child (Indiana Legal Help)

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INSTRUCTIONS: MODIFY CHILD SUPPORT WITH AGREEMENT 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: 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
_______________________
_____________________
Page 2 of 3 Approved by the Coalition for Court Access
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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.:
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
ATTENTIO
N 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 3 Approved by the Coalition for Court Access
CCA-DC-0519-1001
STATE OF INDIANA )
)SS:
COUNTY OF __________________ )
IN THE ______________ _______________ COURT
CAUSE NO. ___________________________________
IN RE THE _________________ OF:
_______________________________
Minor Child (paternity only)
_______________________________
Petitioner,
v.
_______________________________
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
_______________________
_____________________
Page 2 of 3 Approved by the Coalition for Court Access
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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
THIS SECTION MUST BE COMPLETED BY
A NOTARY PUBLIC
Page 3 of 3 Approved by the Coalition for Court Access
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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
THIS SECTION MUST BE COMPLETED BY
A NOTARY PUBLIC
Page 1 of 4 Approved by the Coalition for Court Access
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www.indianalegalhelp.org
STATE OF INDIANA IN THE ______________ _______________ COURT
COUNTY OF __________________ CASE NO. ___________________________________
IN RE THE _________________ OF:
_______________________________
Minor Child (paternity only)
_______________________________
Petitioner,
v.
_______________________________
Respondent.
VERIFIED 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
FOR THE SECTION ABOVE THE DOTTED LINE, LOOK AT
THE COURT PAPERS YOU HAVE IN YOUR CASE AND
COPY THE INFORMATION HERE
-----------------------------------------------------------------------------------------------------------------------------------
PETITIONER NAME
RESPONDENT NAME
NUMBER
MINOR
CHILDREN
NAMES AND BIRTH DATES OF EACH MINOR CHILD
PERSON ORDERED TO PAY CHILD SUPPORT
AMOUNT ORDERED
TO PAY EACH WEEK
PERSON WHO GETS SUPPORT
DATE OF LAST SUPPORT ORDER
PERSON WHO SHOULD NOW PAY SUPPORT
NEW AMOUNT
PERSON WHO WILL GET SUPPORT
Page 2 of 4 Approved by the Coalition for Court Access
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www.indianalegalhelp.org
_________________________. (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.
8. ☐_____________________________ 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 CHILD SUPPORT
SHOULD START
IN PARAGRAPH
#8, IF ONE
PARENT WILL
CARRY
INSURANCE
FOR THE
CHILDREN,
CHECK THE
FIRST BOX AND
FILL IN THAT
PARENT'S
NAME. IF
INSURANCE IS
NOT
AVAILABLE,
CHECK THE
SECOND BOX
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
B OF THE
CHILD
SUPPORT
WORKSHEET
IF YOU AGREE THAT ONLY ONE PARENT
CAN CLAIM THE CHILDREN FOR TAX
PURPOSES, CHECK THE BOX AND PUT
THAT PERSON'S NAME HERE
Page 3 of 4 Approved by the Coalition for Court Access
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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.
-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 penalties for perjury that the foregoing representations and
statements are true.
___________________________________ ____________________________________
Signature Date
STATE OF INDIANA
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,
CHECK THIS
BOX AND
FILL IN THE
YEAR. THEN
SELECT
'EVEN' OR
'ODD.'
PETITIONER'S NAME
RESPONDENT'S NAME
AFTER YOU PRINT THIS FORM, YOU MUST SIGN AND DATE IT IN FRONT OF A NOTARY
THIS SECTION MUST BE COMPLETED BY
A NOTARY PUBLIC
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signature
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Page 4 of 4 Approved by the Coalition for Court Access
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I affirm under penalties for perjury that the foregoing representations and
statements are true.
___________________________________ ____________________________________
Signature Date
STATE OF INDIANA
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: ___________________________
SO ORDERED ________________________________________________________________
____________________________________
Judicial Officer
Distribution:
__________________________________ ____________________________________
__________________________________ ____________________________________
__________________________________ ____________________________________
AFTER YOU PRINT THIS FORM, IT MUST BE SIGNED AND DATED BY THE OTHER PARTY
THIS SECTION MUST BE COMPLETED BY A
NOTARY PUBLIC
LEAVE BLANK
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YOUR NAME AND ADDRESS
OTHER PARTY'S NAME AND ADDRESS
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INSTRUCTIONS: MODIFY CHILD SUPPORT WITH AGREEMENT Minor Child (Indiana Legal Help)

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Completed 31 December 2021

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