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CIRCUIT COURT FOR , MARYLAND
Located at Case No.
PETITION TO MODIFY CHILD SUPPORT
(Family Law Art., Title 12)
MDEC counties only: You must file a Notice Regarding Restricted Information Pursuant to
Rule 20-201.1 (form MDJ-008) with this submission.
NOTE: Complete and attach a financial form to this document. If parents’ combined gross monthly income (not
take home pay) is $15,000 or less, attach Financial Statement (Child Support Guidelines) (CC-DR-030); if the
combined gross monthly income is more than $15,000, attach Financial Statement (General) (CC-DR-031).
My name is and I state that:
1. I am the
☐
mother
☐
father
☐
of the following child(ren)
or adult disabled child(ren), including children who are under age 19, and
are enrolled in secondary school:
Name(s) Date(s) of birth
2. On , the Circuit Court for issued an
order in case number , ordering
to pay $
☐
weekly,
☐
biweekly, or
☐
monthly toward the support of the
child(ren).
3. Since the most recent order, circumstances have changed (check all that apply):
☐
Expenses for the child(ren) have substantially increased (explain):
CC-DR-006 (Rev. 01/2021) Page 1 of 2
Cit
y
/Count
y
Relationshi
p
(
for exam
p
le, aunt,
g
randfather,
g
uardian
)
Court Address
vs.
Defendant Plaintiff
Street Address
Street Address
City, State, Zip Telephone City, State, Zip
Date
City/County
Name
Amount
Name
This form contains Restricted Information.
Telephone
PEMCS
MOMOS
MOMNS
Case No.
☐ Expenses for the child(ren) have substantially decreased (explain):
☐ ’s income has substantially increased (explain):
☐ ’s income has substantially decreased (explain):
☐ The child(ren) is/are no longer entitled to receive child support because the child(ren)
(check all that apply):
☐ has reached the age of 18 and is no longer in high school.
☐ has reached the age of 19.
☐ is married.
☐ is emancipated.
☐ has died.
☐ Other changes have occurred (explain):
FOR TH
ESE REASONS, I request the court (check all that apply):
☐ Order an increase in child support.
☐ Order a decrease in child support.
☐ Order child support to be paid (check one):
☐ by Earnings Withholding Order through the local support enforcement agency.
☐ directly to the person who has custody.
☐ Order to provide health insurance for the child(ren).
☒ Order any other appropriate relief.
I solemnly affirm under the penalties of perjury that the contents of this document are true to the best of my
knowledge, information, and belief.
CC-DR-006 (Rev. 01/2021) Page 2 of 2
Name
Name
Name
Si
g
nature
Printed Name
Tele
p
hone Number
Cit
y
, State, Zi
p
Date
Address
E-mail
Fax
PEMCS
MOMOS
MOMNS
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Completed 21 April 2022

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