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Petitioner, v. (Indiana Legal Help)

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Page 1 of 3 Approved by the Coalition for Court
Access CCA-GF0-3013
www.indianalegalhelp.org
STATE OF INDIANA IN THE __________________ ______________ COURT
COUNTY OF _________________
CASE NO. ________________________________
IN RE THE MARRIAGE OF:
__________________________
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 DC 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
Caption and case number of related cases:
__________________
Page 2 of 3 Approved by the Coalition for Court Access
CCA-GF-1220-3013
www.indianalegalhelp.org
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-1220-3013
www.indianalegalhelp.org
STATE OF INDIANA IN THE __________________ ______________ COURT
COUNTY OF _________________ CASE NO. ________________________________
IN RE THE MARRIAGE OF:
__________________________
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 in this case
Name: SS#
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-12
20-1054
www.indianalegalhelp.org
STATE OF INDIANA
COUNTY OF _______________
IN THE ________________
_______________ COURT
CASE NO. ___________________________________
IN RE THE MARRIAGE OF:
____________________________
Petitioner,
v.
____________________________
Respondent
VERIFIED PETITION TO MODIFY PARENTING TIME WITH AGREEMENT
________________________________________, self represented, files a Petition to
Modify Parenting Time and states in support as follows:
1. The parties’ divorce decree is dated ______________________ .
2. The minor child(ren) is/are named:
_____________________________________________________________________________
and ________________________________ has been ordered to pay child support in the amount
of $_____________________ per week.
3. The last order on parenting time is dated ___________________ and
______________________________________ has primary physical custody.
4. The last order on parenting time states that parenting time shall be as follows:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. A change in parenting time is in the best interest of the child(ren).
6. ___________________________________ asks this Court to change parenting
time and enter a parenting time order:
☐ in accordance with the Indiana Parenting Time Guidelines OR
☐ as follows:
__________________
Page 2 of 2 Approved by the Coalition for Court Access
CCA-DC-1220-1054
www.indianalegalhelp.org
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
7. The parties have reached an agreement and an Agreed Entry To Modify Parenting
Time is filed with this petition.
WHEREFORE, the undersigned prays that the Court modify the parenting time order as
requested, and for all other just and proper relief.
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 2
Approv
ed by the Coalition for Court Access
CCA-DC-1220-1055
www.indianalegalhelp.org
STATE OF INDIANA
COUNTY OF __________________
IN THE ___________________________ COURT
CASE NO._______________________________
IN RE THE MARRIAGE OF:
____________________________
Petitioner,
v.
____________________________
Respondent
VERIFIED AGREED ENTRY TO MODIFY PARENTING TIME
________________________________ and _________________________________ file an
Agreed Entry to Modify Parenting Time and state they agree as follows:
1. The parties’ marriage was dissolved by Decree dated ______________________ .
2. ________________________________________ has been awarded primary
physical custody of the child(ren), namely:
_____________________________________________________________________________
and ____________________________ has been ordered to pay child support in the amount of
$___________________ per week.
3. A change in parenting time is in the best interest of the minor child(ren).
4. The parties waive a hearing and ask the Court to modify the parenting time order
☐in accordance with the Indiana Parenting Time Guidelines OR
☐as follows:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
__________________
Page 2 of 2
Approved by the Coalition for Court Access
CCA-DC-12
20-1055
www.indianalegalhelp.org
WHEREFORE the parties waive their right to a hearing, ask that the Court modify
parenting time as outlined in the Verified Agreed Entry To Modify Parenting Time and for all
other just and proper relief.
I affirm under penalties for perjury that the foregoing representations and
statements are true.
Date: ______________________________ ____________________________________
Petitioner Signature
____________________________________
Printed Name
STATE OF INDIANA
COUNTY OF ______________________
Before 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.
Date: _______________________________ ____________________________________
Notary Public
My Commission Expires ____________________________________________
I affirm under penalties for perjury that the foregoing representations and statements
are true.
Date: ______________________________ ____________________________________
Respondent Signature
____________________________________
Printed Name
STATE OF INDIANA
COUNTY OF ______________________
Before 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.
Date: _______________________________ ____________________________________
Notary Public
My Commission Expires ____________________________________________
SO ORDERED ________________________________________________________________
____________________________________
Distribution: Judicial Officer
__________________________________ ____________________________________
__________________________________ ____________________________________
__________________________________ ____________________________________
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Petitioner, v. (Indiana Legal Help)

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Completed 31 December 2021

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