Request To Modify Child Support Pursuant To Guidelines Simplified Procedure Form
Download a blank fillable Request To Modify Child Support Pursuant To Guidelines Simplified Procedure Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Request To Modify Child Support Pursuant To Guidelines Simplified Procedure Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2(1) Name of Person Filing: _________________________________________
Person filing is the: Petitioner Respondent
Mailing Address (if not protected):__________________________________
City, State, Zip Code: ____________________________________________
Phone Number:
____________________________________________
I am representing myself, without an attorney
(If Attorney) State Bar Number __________________________
For Clerk Use Only
Attorney E-Mail Address: _______________________________
SUPERIOR COURT OF ARIZONA IN
COUNTY
(2) ________________________
Case No.
(3)
(5)
Name of Petitioner
REQUEST TO MODIFY
CHILD SUPPORT PURSUANT
TO GUIDELINES SIMPLIFIED
(4)
PROCEDURE
Name of Respondent
IMPORTANT NOTICE TO PARTY NOT REQUESTING THE MODIFICATION
Your support order may be modified if you do not request a hearing.
(6) The Petitioner, or Respondent asks this court to modify the Arizona child support order in this
case entered on (7) ____/_____/_______ by (8)_________________________________.
(month/day/year)
(Name of judge or commissioner)
A. Under the current child support order (9):
medical dental vision care insurance
Mother is responsible for providing
medical dental vision care insurance
Father is responsible for providing
medical dental vision care insurance
Neither party was ordered to provide
B. The child support order currently in effect requires the (10) Mother, or the Father to make
payments of (11) $___________ per month, payable on the _________ day of the month.
C. Attached is a Parent's Worksheet for Child Support Amount. According to the worksheet
calculations the child support amount should be (12) $
per month.
D. The following calculations show that the requested change varies from the current-ordered child
support amount by 15% or more.
(13)(a)
divided by (b)
= (c)
%
a = the difference between the amount currently ordered and the amount requested
b = the amount currently ordered; and
c = the percentage change
E. Is the Division of Child Support Services (DCSS) providing child support enforcement services for at
least one of the parties? (14) Yes No Unknown (If “Yes” is selected, see instructions for
providing notice to the State.)
E. Other court-ordered payments included in the current Income Withholding Order dated:
(15) ___/_____/____ (month/day/year).
Arizona Supreme Court – Self Service Center
Page 1 of 2
July 2013
Request to Modify Child Support – Simplified Procedure
ADVERTISEMENT
0 votes
