Children

a. Child Support

What child support should be. Only fill this in if you also want child support changed. State the new monthly amount you want the judge to order. Describe the reasons and the substantial and continuing change in your circumstances that require a change in child support. Only fill this in if you also want child support changed. Explain what major life change makes a new amount necessary. Name Write the full name of your first child that you share with the other party.

b. Children's Basic Information

Date of Birth Write the day this child was born. Name Write the full name of your second child that you share with the other party. Date of Birth Write the day this child was born. Name Write the full name of your third child that you share with the other party. Date of Birth Write the day this child was born. Name Write the full name of your fourth child that you share with the other party. Date of Birth Write the day this child was born. Name Write the full name of another person you help support. Age Write how old that person is. Relationship to You Tell how this person is related to you, like a parent or relative. Reside With You (Y/N) Write Y if this person lives with you, or N if they do not. Court Order to Support (Y/N) Write Y if a court ordered you to support this person, or N if not.

c. Health & Medical Support

Do you have health insurance available? Check Yes if you can get health insurance for yourself or your children. Check No if you cannot. Are you enrolled? Tell whether you are signed up for the health insurance right now. Total monthly cost Write the full amount you pay each month for the health insurance plan. Premium cost to insure you alone Write what it costs each month to cover only yourself, not anyone else. Premium cost to insure child(ren) common to the parties Write the monthly cost to cover the children you and the other parent share. List all people covered by your insurance coverage: List the names of everyone your health insurance pays for. Name of insurance company and Policy/Group Number: Write the name of your health insurance company and your policy or group number. Total monthly cost Write the full amount you pay each month for dental or vision insurance. Premium cost to insure you alone Write what it costs each month to cover only yourself for dental or vision. Premium cost to insure child(ren) common to the parties Write the monthly cost to cover the children you and the other parent share. List all people covered by your insurance coverage: List the names of everyone your dental or vision insurance pays for. Name of insurance company and Policy/Group Number: Write the name of your dental or vision insurance company and your policy or group number. Name(s) of child(ren) cared for and amount per child: Write the full name of the first child who receives child care. Name(s) of child(ren) cared for and amount per child: Write the full name of the second child who receives child care. Name(s) of child(ren) cared for and amount per child: Write the full name of the third child who receives child care. Name(s) and address(es) of child care provider(s): List the name and full address of each person or place that provides the child care. Name(s) and relationship of minor child(ren) who you support or who live with you, but are not common to the parties. List the children under 18 who live with you or whom you support, but who are not children of both you and the other party. Include each child's name and how they are related to you. Name Write the full name of your first child shared with the other party.

d. Children's Basic Information

Date of Birth Enter the day, month, and year this child was born. Name Write the full name of your second child shared with the other party. Date of Birth Enter the day, month, and year this child was born. Name Write the full name of your third child shared with the other party. Date of Birth Enter the day, month, and year this child was born. Name Write the full name of your fourth child shared with the other party. Date of Birth Enter the day, month, and year this child was born. Name Write the full name of another person you help pay for, like a parent or other relative. Age Write how old that person is. Relationship to You Explain how this person is related to you, like mother, father, or grandchild. Reside With You (Y/N) Write Y if this person lives with you, or N if they do not. Court Order to Support (Y/N) Write Y if a court order says you must support this person, or N if there is no order.

e. Health & Medical Support

Do you have health insurance available? Check Yes if you can get health insurance through work or another plan. Check No if you cannot. Are you enrolled? Write Yes if you are signed up for the health insurance now, or No if you are not. Total monthly cost Enter the full amount you pay each month for your health insurance plan. Premium cost to insure you alone Enter the monthly cost to cover only yourself, without anyone else on the plan. Premium cost to insure child(ren) common to the parties Enter the extra monthly amount you pay to cover the children you share with the other party. List all people covered by your insurance coverage: List the full names of everyone covered by your health insurance plan. Name of insurance company and Policy/Group Number: Write the name of your health insurance company and the policy or group number from your insurance card. Total monthly cost Enter the full amount you pay each month for your dental or vision insurance. Premium cost to insure you alone Enter the monthly cost to cover only yourself for dental or vision, without anyone else. Premium cost to insure child(ren) common to the parties Enter the extra monthly amount you pay to cover the children you share for dental or vision. List all people covered by your insurance coverage: List the full names of everyone covered by your dental or vision plan. Name of insurance company and Policy/Group Number: Write the name of your dental or vision insurance company and the policy or group number from your card. Name(s) of child(ren) cared for and amount per child: Write the name of the first child who receives the child care. Name(s) of child(ren) cared for and amount per child: Enter the monthly child care cost for this first child. Name(s) of child(ren) cared for and amount per child: Write the name of the second child who receives the child care. Name(s) of child(ren) cared for and amount per child: Enter the monthly child care cost for this second child. Name(s) of child(ren) cared for and amount per child: Write the name of the third child who receives the child care. Name(s) of child(ren) cared for and amount per child: Enter the monthly child care cost for this third child. Name(s) and address(es) of child care provider(s): List the name and full address of each person or place that provides the child care. Name(s) and relationship of minor child(ren) who you support or who live with you, but are not common to the parties. List the names of any children you support or who live with you who are not your shared children with the other party, and how each is related to you.