Fill - Free fillable Minor Child (paternity only) Petitioner, (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,

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:

__________________

_________________

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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

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CCA-DC-0320-1069

www.indianalegalhelp.org

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. 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

__________________

_____

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CCA-DC-0519-1019

STATE OF INDIANA ) IN THE ______________ _______________ COURT

)SS:

COUNTY OF __________________ ) CASE NO. ___________________________________

IN RE THE _________________ OF:

_______________________________

Minor Child (paternity only)

_______________________________

Petitioner,

v.

_______________________________

Respondent.

VERIFIED PETITION FOR COLLEGE EXPENSES AND/OR SPECIAL MEDICAL,

HOSPITAL OR DENTAL EXPENSES

Comes now ________________________________, self represented, and states or affirms as

follows:

1. That parties are the parents of the following children:

Name Age Date of birth

______

2. On or about __________________, this Court entered an Order of Support for child(ren)

in the amount of $__________________ per week.

3. At that time, the Court did not enter an Order with respect to the payment of college

expenses or special medical, hospital, or dental expenses for the child(ren) beyond the age of emancipation

of the child(ren).

4. ______________________ will be attending _________________________ as a

____________________________ student beginning ____________________.

__________________

_________________

_______________

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CCA-DC-0519-1019

5. For the year 20____/20____, the anticipated educational expenses are

_______________________ after all scholarships, grants and non-repayable financial aid is deducted.

(Note: You must provide documentation at or before the court hearing).

6. The child(ren) has/have special medical, hospital or dental expenses. Specifically:

____________________________________________________________________________________

7. The parties are capable of paying for a portion of the reasonable educational expenses,

including tuition, room and board, transportation, fees, books and supplies, and special medical, hospital

or dental expenses.

8. My gross (before tax) weekly income is $______________ per week.

9. The ____________________ has a gross (before tax) weekly income of $______________

per week.

10. I am seeking an Order for the payment of college expenses and/or special medical, hospital

or dental expenses for the child(ren).

WHEREFORE, I request that this Court:

a. Set this matter for hearing for the purpose of determining contribution towards college

expenses, special medical, hospital, or dental expenses.

b. Direct the parties to produce proof of income, including last year’s W-2’s and tax returns

and year-to-date paystubs.

c. Enter an Order for college expenses and special medical, hospital, or dental expenses.

d. Modify the existing order of current support for the child(ren).

Grant all further and proper relief 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

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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 _____________________________________, self represented, having filed a

Verified Petition For College Expenses And/Or Special Medical, Hospital or Dental Expenses, 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:

___________________________________________

__________________

_________________

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CCA-DC-0519-1021

STATE OF INDIANA ) IN THE ______________ _______________ COURT

)SS:

COUNTY OF __________________ ) CASE NO. ___________________________________

IN RE THE _________________ OF:

_______________________________

Minor Child (paternity only)

_______________________________

Petitioner,

v.

_______________________________

Respondent.

ORDER FOR COLLEGE EXPENSES AND/OR SPECIAL MEDICAL, HOSPITAL OR

DENTAL EXPENSES

Comes now ________________________________, self represented, and having filed a Verified

Petition for College Expenses And/Or Special Medical, Hospital or Dental Expenses and

______________________________, self represented and the Court having held a hearing and having

been duly advised as to the financial status of the parties, and having utilized the Indiana Child Support

Guidelines, and having evaluated the needs of the child(ren) now finds as follows:

1. That that child(ren), namely ________________________________, is required to

contribute toward post-secondary school expenses by paying the amount equivalent to $_____________

per semester. Payment shall be made in the following manner:

____________________________________________________________________________________

___________________________________________________________________________________.

2. That ______________________ is to contribute toward the post-secondary school

expenses of the child(ren), namely __________________________________, by paying the amount

equivalent to $______________________ per semester. Payment shall be made in the following manner:

__________________

_________________

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CCA-DC-0519-1021

____________________________________________________________________________________

___________________________________________________________________________________.

3. That ______________________ is to contribute toward the post-secondary school

expenses of the child(ren), namely __________________________________, by paying the amount

equivalent to $______________________ per semester. Payment shall be made in the following manner:

____________________________________________________________________________________

___________________________________________________________________________________.

4. _________________________________ is required to maintain health insurance coverage

for the child(ren), namely _______________________________, so long as the child(ren) remains

eligible for coverage.

5. ________________________________ is required to contribute towards the special

medical, hospital, or dental expenses of the child(ren), namely __________________________, not

otherwise covered by insurance in the amount of $_________________ per year, or ________%.

6. ________________________________ is required to contribute towards the special

medical, hospital, or dental expenses of the child(ren), namely __________________________, not

otherwise covered by insurance in the amount of $_________________ per year, or ________%.

7. The existing child support obligation for the child(ren) in the amount of $___________ per

week, is terminated effective the first Friday following the date of this Order.

8. The current child support obligation for the remaining unemancipated children:

Name Date of birth

shall be $_________________ per week, effective _______________________, health insurance

coverage must be provided by _________________________________ and the custodial parent must be

responsible for the first $______________ (6%) per year of reasonable medical, dental, hospital,

pharmaceutical and optical expenses not covered by insurance, with the balance being split between the

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CCA-DC-0519-1021

parties, with ________________________ paying _____% and ______________________________

paying _______ %.

9. The child support arrearage, if any, due and owing to the _________________________

as of _____________________, 20____, is in the amount of $_______________. The

__________________________ must pay this amount at the rate of $_________________ per week until

the same is paid and fully satisfied.

10. 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.

SO ORDERED______________________________________________________________________

____________________________________

Judicial Officer

Distribution:

____________________________

Fill Online, Printable, Fillable, Blank Minor Child (paternity only) Petitioner, (Indiana Legal Help) Form

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Fillable Minor Child (paternity only) Petitioner, (Indiana Legal Help)

Fill Online, Printable, Fillable, Blank Minor Child (paternity only) Petitioner, (Indiana Legal Help) Form

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