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Minor Child (Indiana Legal Help)

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Page 1 of 3 Approved by the Coalition for Court Access
CCA-GF-0720-3014
www.indianalegalhelp.org
STATE OF INDIANA IN THE __________________ ______________ COURT
COUNTY OF _________________ CASE NO. ________________________________
IN RE THE __________________ OF:
__________________________
Minor Child
__________________________
Petitioner,
v.
__________________________
Respondent.
APPEARANCE BY UNREPRESENTED PERSON
1. My name is _________________________________ and in this case I am not represented
by a lawyer.
2. My contact information for receiving legal service of documents and case information as
required by Court Rules is:
Address:
Email address:
☐ I will accept service at the above email address.
Phone:
Fax:
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).
4. There are other cases related to this case: (If yes, please indicate below)
☐ Yes
☐ No
__________________
________
_____
Page 2 of 3 Approved by the Coalition for Court Access
CCA-GF-0720-3014
www.indianalegalhelp.org
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 document on ________________________ by
☐ e-service using the e-filing system
☐ first-class U.S. mail, postage prepaid
☐ hand delivery
to _____________________________________ at the following address:
______________________________
______________________________
______________________________
______________________________
Signature
Page 3 of 3 Approved by the Coalition for Court Access
CCA-GF-0720-3014
www.indianalegalhelp.org
STATE OF INDIANA IN THE __________________ ______________ COURT
COUNTY OF _________________ CASE NO. ________________________________
IN RE THE ___________________ OF:
__________________________
Minor Child
__________________________
Petitioner,
v.
__________________________
Respondent.
NOT FOR PUBLIC ACCESS
IN ACCORDANCE WITH INDIANA RULES ON
ACCESS TO COURT RECORDS
ATTENTION CLERK: FOR SELF REPRESENTED LITIGANTS TREAT THIS FORM AS
IF IT IS PRINTED ON LIGHT GREEN PAPER
CIVIL APPEARANCE FORM
Social security numbers of parents and minor child
Name: SS#
Name: SS#
Name: SS#
Name: SS#
Name: SS#
Name: SS#
NOT FOR PUBLIC ACCESS
__________________
__________________
Page 1 of 2 Approved by the Coalition for Court
Access CCA-DC-0720-1045
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 PETITION TO MODIFY CUSTODY WITHOUT AN AGREEMENT
________________________________, self represented, files a Verified Petition to
Modify Child Custody and states as follows:
1. The parties have _____ minor child(ren), whose names and dates of birth are as
follows:
Name Date of Birth
________________________________ ________________________________
________________________________ ________________________________
________________________________ ________________________________
________________________________ ________________________________
________________________________ ________________________________
2. By prior court order dated _________________, __________________________
has custody of the parties’ minor child(ren).
3. Since that time, there has been a substantial change in circumstances as described
here:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
__________________
P
age 2 of 2 Approved by the Coalition for Court Access
CCA-DC-0720-1045
www.indianalegalhelp.org
4.
It is in the minor child(ren)’s best interests, in consideration of the above, that the
Court change custody of the minor child(ren) from ________________________ to
______________________________.
5. The Court should set a hearing to determine if custody should change.
6. If the Court grants the petition, the Court should also modify the existing child
support order and parenting time orders to reflect the change in the custody order.
WHEREFORE, ___________________________ requests that the Court set this matter
for hearing, and after a hearing, modify custody of the minor child(ren), modify the existing
child support and parenting time orders as is appropriate, and order all other relief that is just and
proper in the premises.
I affirm under penalties for perjury that the foregoing representations and
statements are true.
Date: _____________________________ ____________________________________
Signature
____________________________________
Printed name
CERTIFICATE OF SERVICE
I hereby certify that I sent a copy of this document on ________________________ by
☐ e-service using the e-filing system
☐ first-class U.S. mail, postage prepaid
☐ hand delivery
to _____________________________________ at the following address:
______________________________
______________________________
______________________________
______________________________
Signature
Page 1 of 1 Approved by the Coalition for Court
Access CCA-DC-0720-1047
www.indianalegalhelp.org
STATE OF INDIANA
COUNTY OF ___________________
IN THE _________________ ______________COURT
CASE NO. _______________________________
IN RE THE __________________ OF:
________________________
Minor Child (Paternity Only)
________________________
Petitioner,
v.
________________________
Respondent.
ORDER SETTING HEARING
___________________________, self represented, having filed a Verified Petition to
Modify Child Custody Without An Agreement, and the Court now finds the Petition should be
set for a hearing.
IT IS THEREFORE ORDERED that this matter shall be heard on
_____________________________________________________________________________.
Dated: _________________________________ ____________________________________
Judicial Officer
Distribution:
_______________________________ ________________________________
_______________________________ ________________________________
_______________________________ ________________________________
_______________________________ ________________________________
__________________
________
Page 1 of 1 Approved by the Coalition for Court Access
CCA-DC-1119-1046
www.indianalegalhelp.org
STATE OF INDIANA
COUNTY OF ___________________
IN THE _________________ ______________COURT
CASE NO. _______________________________
IN RE THE __________________ OF:
________________________
Minor Child (Paternity Only)
________________________
Petitioner,
v.
________________________
Respondent.
ORDER GRANTING MODIFICATION OF CUSTODY
Comes now the _______________________________, self represented, having filed a
Verified Motion To Modify Custody Without An Agreement and comes now/not
_________________________________, self represented/with counsel. Evidence heard and
concluded. The Court now finds that there has been a substantial change in applicable factors as
to warrant a modification in the current custody order.
The Court now ORDERS as follows:
1. The current custody order is modified, and custody of the minor child(ren) shall
be granted to _______________________________.
2. _________________________________________ will pay support to
_______________________________________ in the amount of: $_________________ per
week, per the Child Support Guidelines Worksheets attached.
3. _________________________:
☐ shall have parenting time in accordance with the Indiana Parenting Time
Guidelines OR
☐ a deviation from the Indiana Parenting Time Guidelines is warranted and
parenting time shall be as follows:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
So ordered this __________________________________________________________.
_____________________________________
Distribution: Judicial Officer
____________________________ ____________________________
____________________________ ____________________________
____________________________ ____________________________
____________________________ ____________________________
__________________
________
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Minor Child (Indiana Legal Help)

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Completed 31 December 2021

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