Fillable Minor Child Petitioner, (Indiana Legal Help)

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Minor Child Petitioner, (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-0720-1042
www.indianalegalhelp.org
STATE OF INDIANA
COUNTY OF ___________________
IN THE ___________________________ COURT
CASE NO. _______________________________
IN RE THE __________________ OF:
________________________
Minor Child (Paternity Only)
________________________
Petitioner,
v.
________________________
Respondent.
VERIFIED PETITION TO MODIFY CUSTODY WITH 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:
__________________
Page 2 of 2 Approved by the Coalition for Court Access
CCA-DC-0720-1042
www.indianalegalhelp.org
4. It is in the minor child(ren)’s best interest(s), in consideration of the above, that
the Court change custody of the minor child(ren) from ________________________ to
______________________________.
5. An Agreed Entry To Modify Custody is filed with this Petition.
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 grant this
petition, 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 3 Approved by the Coalition for Court
Access CCA-DC-0720-1043
www.indianalegalhelp.org
STATE OF INDIANA
COUNTY OF ___________________
IN THE ___________________________ COURT
CASE NO. _______________________________
IN RE THE __________________ OF:
________________________
Minor Child (Paternity Only)
________________________
Petitioner,
v.
________________________
Respondent.
VERIFIED AGREED ENTRY TO MODIFY CUSTODY
________________________________, 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:
4. It is in the minor child(ren)’s best interest(s), in consideration of the above, that the Court
change custody of the minor child(ren) from ________________________ to
______________________________.
__________________
Page 2 of 3 Approved by the Coalition for Court
Access CCA-DC-0720-1043
www.indianalegalhelp.org
5. In accordance with the attached Child Support Worksheet,
___________________________ shall pay child support to _________________________ in the
amount of $_________________ per week beginning the date this agreement is signed by the Court.
6. _____________________________:
☐ 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:
7.
The
parties waive their right to a hearing.
Page 3 of 3 Approved by the Coalition for Court
Access CCA-DC-0720-1043
www.indianalegalhelp.org
WHEREFORE, ___________________________ and___________________________ waive
their right to a hearing, request that the Court grant this petition, 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
STATE OF INDIANA
COU
NTY OF ______________________
Bef
ore me, _______________________________, a notary public in and for __________________________
County, State of Indiana, personally appeared _______________________________________ and having been
duly sworn upon their oath says that the facts all alleged in the foregoing instrument are true.
Dat
e: _______________________________ ____________________________________
Notary Public
My Commission Expires ____________________________________________
I affirm under penalties for perjury that the foregoing representations and statements are
true.
Date: ______________________________ ____________________________________
Signature
____________________________________
Printed Name
STATE OF INDIANA
COU
NTY OF ______________________
Bef
ore me, _______________________________, a notary public in and for __________________________
County, State of Indiana, personally appeared _______________________________________ and having been
duly sworn upon their oath says that the facts all alleged in the foregoing instrument are true.
Dat
e: _______________________________ ____________________________________
Notary Public
My Commission Expires ____________________________________________
SO ORDERED ________________________________________________________________
____________________________________
Distribution: Judicial Officer
__________________________________ ____________________________________
__________________________________ ____________________________________
__________________________________ ____________________________________
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Minor Child Petitioner, (Indiana Legal Help)

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Completed 31 December 2021

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