4. The children for whom support was ordered are:
Name DOB Name DOB
5. I am the child(ren)’s: (check the applicable box)
Parent or guardian.
Support assignee.
Other (describe):__________________________________________
6. The other party is the child(ren)’s (check the applicable box)
Parent or guardian.
Support assignee.
Other (describe):__________________________________________
7. The obligation under the current order is.
I am required to pay: (fill in all lines that apply)
$__________ per _____________ in Child Support.
$__________ per _____________ in Maintenance Supplement.
$__________ per _____________ in Spousal Support (Spousal Maintenance
or Alimony).
The other party is required to pay: (fill in all lines that apply)
$__________ per _____________ in Child Support.
$__________ per _____________ in Maintenance Supplement.
$__________ per _____________ in Spousal Support (Spousal Maintenance
or Alimony).
8. I am requesting that the Court modify the child support and/or spousal support order 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: _________________________________
The child support order was issued more than three years ago.