400-00803 – Motion to Modify Child Support, Maintenance Supplement (09/2018) Page 1 of 3
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Name
DOB
V.
Name
DOB
NOTICE OF APPEARANCE & INTENT TO REPRESENT MYSELF
I intend to represent myself and hereby enter my appearance with the Court. No attorney will represent me
in this case unless an attorney or I notify the Court otherwise.
I understand that IT IS MY RESPONSIBILITY TO:
1. Notify the Court in writing if I change my address or phone number; and
2. Send copies of any papers I file with the Court to the other party in this case.
All Court papers may be mailed to me by first class mail at the address listed below.
Name: __________________________________________ Date of Birth: ______________________
Street Address: ___________________________________ City/State/Zip: _____________________
Mailing Address (if different from Street Address): _____________________________________________________
City/State/Zip: ___________________________________ Email Address: _____________________
Daytime Phone: __________________________________ Evening Phone: _____________________
MOTION TO MODIFY CHILD SUPPORT, and/or MAINTENANCE SUPPLEMENT
1.
I am the Plaintiff Defendant Office of Child Support
2.
The other party is the Plaintiff Defendant
3.
I request that the Court modify a child support order issued on (date) _______________________.
By this Court
By another Court: __________________________________________________________
Name of Court
_____________________________________________________________
Address of Court
4. The children for whom support was ordered are:
Name Date of Birth
_______________________________ ____________________________
_______________________________ ____________________________
_______________________________ ____________________________
_______________________________ ____________________________
_______________________________ ____________________________
5. I am the child(ren)’s (check the appropriate box)
Parent or guardian
Support assignee
Other (describe): __________________________________________________________________
400-00803 – Motion to Modify Child Support, Maintenance Supplement (09/2018) Page 2 of 3
6. The other party is the child(ren)’s: (check the appropriate box)
Parent or guardian
Support assignee
Other (describe): __________________________________________________________________
7. The obligation under the current order is:
I am required to pay: (check the appropriate box & fill in information)
$_______________ per _______________ in Child Support
$_______________ per _______________ in Maintenance Supplement
The other party is required to pay: (check the appropriate box & fill in information)
$_______________ per _______________ in Child Support
$_______________ per _______________ in Maintenance Supplement
8. I am requesting that the Court modify the child support and/or maintenance supplement by:
increasing the monthly support amount.
decreasing the monthly support amount.
9. There has been a real, substantial and unanticipated change in circumstances because:
(check all that apply)
My income has decreased.
My income has increased.
Other party’s income has increased.
Other party’s income has decreased.
I am unemployed.
Other party is unemployed.
The number of children subject to the order has changed.
It has been more than 3 years since child support was modified.
I am disabled because: ________________________________________________________
10. If child support were calculated today under the Child Support Guidelines, the existing monthly
support amount would:
Increase by more than 10%
Decrease by more than 10%
I do not know what the current support obligation would be under the Child Support Guidelines.
11. In support of this motion, I have attached an Affidavit of Income and Expenses.
400-00803 – Motion to Modify Child Support, Maintenance Supplement (09/2018) Page 3 of 3
REQUEST TO THE COURT
I request that the Court:
Modify the monthly child support obligation using the Child Support Guidelines.
Increase child support obligation $ per month.
Decrease child support obligation $_ per month.
Increase maintenance supplement obligation $ per month.
Decrease maintenance supplement obligation $ per month.
Grant any other relief this Court determines is appropriate.
I hereby swear or affirm that the information above is true to the best of my knowledge and belief.
Dated
_________________________ ____________________________
Signature
S
igned and sworn to or affirmed before me:
Date Signature of Notary Public Expiration Date