Supplemental Petition to Modify Child Support · Step 3 of 4
Signature & Certification
mailed
Check this box if you sent the copy through regular mail.
faxed and mailed
Check this box if you sent the copy by both fax and mail.
e-mailed
Check this box if you sent the copy by email.
hand-delivered
Check this box if you gave the copy to the person in person.
on {date}
Enter the date you sent or delivered the copy.
Name:
Write the full name of the other party or their lawyer who gets the copy.
Address:
Write the street address where the other party or their lawyer receives mail.
City, State, Zip:
Write the city, state, and zip code for the other party's address.
Fax Number:
Write the other party's fax number if you have one.
Designated E-mail Address(es):
Write the email address the other party uses for court papers.
Signature of Party
Sign here to show the information you gave is true.
Printed Name:
Print your full name clearly.
Address:
Write your street address where you receive mail.
City, State, Zip:
Write your city, state, and zip code.
Telephone Number:
Write a phone number where you can be reached.
Fax Number:
Write your fax number if you have one.
Designated E-mail Address(es):
Write the email address you use for court papers.
Petitioner
Check this if the form was prepared for the person who started the case.
Respondent
Check this if the form was prepared for the person responding to the case.
{name of individual }
Write the full name of the person who is not a lawyer and helped fill out this form.
{name of business}
Write the name of the business where the helper works.
{address}
Write the street address of the person or business that helped you.
{city}
Write the city for the helper's address.
{state}
Write the state for the helper's address.
{zip code}
Write the zip code for the helper's address.
{telephone number}
Write a phone number for the helper.
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