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: TERMINATE CHILD SUPPORT WITHOUT AGREEMENT DUE TO EMANCIPATION
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)
__________________
_________________
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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-0519-1013
STATE OF INDIANA ) IN THE ______________ _______________ COURT
)SS:
COUNTY OF __________________ ) CASE NO. ___________________________________
IN RE THE _________________ OF:
_______________________________
Minor Child (paternity only)
_______________________________
Petitioner,
v.
_______________________________
Respondent.
VERIFIED PETITION TO TERMINATE CHILD SUPPORT DUE TO EMANCIPATION OF
MINOR CHILD(REN)
Comes now ________________________________, self represented, and hereby files a Verified
Petition to Terminate Child Support Due to Emancipation of Minor Child(ren), and states as follows:
1. That parties have ______ minor child(ren), namely:
Name Date of birth
2. On __________________, this Court ordered that _______________________________
pay child support to _________________________________ in the weekly amount of ______________
for the above name child(ren) effective on __________________.
3. The following child(ren) is/are emancipated:
___________________________________________________________________________________
4. The reason that my child(ren) is/are emancipated as follows:
FOR THE SECTION ABOVE THE DOTTED LINE LOOK
AT THE OTHER PAPERS YOU HAVE IN THIS CASE AND
COPY THE INFORMATION HERE
---------------------------------------------------------------------------------------------------------------------------------
FULL NAME
NUMBER
MINOR
CHILDREN
NAMES AND DATES OF BIRTH OF MINOR CHILDRE YOU AND THE OTHER
PARTY HAVE TOGETHER
DATE OF CHILD
SUPPORT ORDER
PERSON WHO PAYS CHILD SUPPORT
PERSON WHO GETS CHILD SUPPORT
WEEKLY SUPPORT
ORDERED
DATE SUPPORT ORDER TOOK EFFECT
NAME OF EMANCIPATED CHILD
__________________
_________________
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CCA-DC-0519-1013
_____________________________ has turned nineteen (19) years of age.
_____________________________ is at least eighteen (18) years of age; has not
attended secondary or post-secondary school for the past four (4) months and is not enrolled in a secondary
or post-secondary school; and is or is capable of supporting himself/herself through employment.
_____________________________ has joined the United States armed services.
_____________________________ has married.
_____________________________ is not under the care or control of either parent
nor an individual or agency approved by the court.
5. The date upon which my child(ren) became emancipated was ___________________.
6. My child support obligation should be terminated because of the emancipation of my
child(ren), _______________________________________________________________________.
7. The termination of my support obligation should be retroactive to the date(s) stated in
Paragraph 5 above.
8. The Income Withholding Order previously issued in this matter should be terminated.
WHEREFORE,_____________________________ requests that this Court set this matter for
hearing for the purpose of declaring my child(ren) emancipated, terminating my child support obligation,
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
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
FOR
PARAGRAPH 4,
SELECT EACH
BOX
THAT APPLIES
TO THE
EMANCIPATED
CHILD AND
WRITE THEIR
NAME IN THE
BLANK
DATE OF EMANCIPATION
EMANCIPATED CHILD
YOUR NAME
PRINT THIS DOCUMENT AND THEN SIGN AND DATE HERE
DATE YOU SENT THESE DOCUMENTS
TO THE OTHER PARTY
PRINT THIS DOCUMENT AND THEN SIGN AND DATE HERE
Page 1 of 1 Approved by the Coalition for Court Access
CCA-DC-0519-1014
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 _____________________________________, pro se, having filed a Verified
Petition To Terminate Child Support Due To Emancipation Of Minor Child(ren), 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 OTHER PAPERS YOU HAVE IN THIS CASE
AND COPY THE INFORMATION HERE
-------------------------------------------------------------------------------------------------------------------------------------
YOUR NAME
LEAVE BLANK
LEAVE BLANK
LEAVE BLANK
SELECT THE
BOX THAT
INDICATES HOW
THESE
DOCUMENTS
WILL BE GIVEN
TO THE OTHER
PARTY, THEN
FILL IN THEIR
NAME AND
ADDRESS. FEES
MAY APPLY
PETITIONER
RESPONDENT
Page 1 of 2 Approved by the Coalition for Court
Access
CCA-DC-0519-1012
STATE OF INDIANA
) IN THE ___________________ _____________ COURT
)SS:
COUNTY OF _________________ ) CASE NO. __________________________________
IN RE THE ____________________ OF:
_______________________________
Minor Child (paternity only)
_______________________________
Petitioner,
v.
_______________________________
Respondent
ORDER GRANTING TERMINATION OF CHILD SUPPORT DUE TO EMANCIPATION OF
MINOR CHILD(REN)
Comes now, ______________________, self represented, having filed a Verified Petition to
Terminate Child Support Due to Emancipation of Minor Child(ren). The Court, having read said
pleading and held a hearing on the matter, now finds that the child support obligation should be
terminated because of the emancipation of the minor child(ren).
IT IS THEREFORE ORDERED that:
1. On ____________________, ________________________ became emancipated.
2. The current child support obligation should be terminated because of the emancipation of
the minor child(ren).
3. The current Income Withholding Order should be terminated because of the emancipation
of the minor child(ren).
4. There is not an arrearage on this account and the arrearage is set at zero and the
account shall be closed.
-OR-
FOR THE SECTION ABOVE THE DOTTED LINE LOOK AT
THE OTHER PAPERS YOU HAVE IN THIS CASE AND COPY
THE INFORMATION HERE
-------------------------------------------------------------------------------------------------------------------------------------
YOUR NAME
DATE EMANCIPATED
NAME OF CHILD
LEAVE BLANK
__________________
_________________
Page 2 of 2 Approved by the Coalition for Court
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CCA-DC-0519-1012
There is an arrearage on this account of $____________.
________________________________is ordered to pay $_______________ per week on the arrearage
until such time as the arrearage is paid in full.
So ordered ________________________________________________________________________
__________________________________
Judicial Officer
Distribution:
________________________________________
________________________________________
LEAVE BLANK
LEAVE BLANK
PETITIONER
RESPONDENT
LEAVE BLANK