Children

a. General Information

(Name of party) ____________________________________ Write the full name of the person who currently pays child support under the existing order.

b. Child Support

currently pays (amount) $_______ per month in child support Enter the dollar amount paid each month for child support right now. for (number) ____ minor children Enter how many children are covered by the current child support order.

c. Children's Basic Information

Child's Name: Write the full name of your first child. Date of Birth Enter the date your first child was born. Joint physical custody Check this if both parents share physical custody of this child. I have Primary/Sole physical custody Check this if you have main or full physical custody of this child. Other parent has Primary/Sole physical custody Check this if the other parent has main or full physical custody of this child. Child's Name: Write the full name of your second child. Date of Birth Enter the date your second child was born. Joint physical custody Check this if both parents share physical custody of this child. I have Primary/Sole physical custody Check this if you have main or full physical custody of this child. Other parent has Primary/Sole physical custody Check this if the other parent has main or full physical custody of this child. Child's Name: Write the full name of your third child. Date of Birth Enter the date your third child was born. Joint physical custody Check this if both parents share physical custody of this child. I have Primary/Sole physical custody Check this if you have main or full physical custody of this child. Other parent has Primary/Sole physical custody Check this if the other parent has main or full physical custody of this child. Child's Name: Write the full name of your fourth child. Date of Birth Enter the date your fourth child was born. Joint physical custody Check this if both parents share physical custody of this child. I have Primary/Sole physical custody Check this if you have main or full physical custody of this child. Other parent has Primary/Sole physical custody Check this if the other parent has main or full physical custody of this child. The following child(ren) has/have emancipated (write name(s)): Write the name of each child who is now grown up or legally on their own. (explain the custodial schedule you have been following): Describe the parenting time schedule you have actually been following, such as which days each child stays with each parent.

d. Child Support

It is in the children's best interest to modify child support because (tell the judge why it is in the children's best interest to change child support): Explain how changing the support amount will help your children. Use simple facts about their needs. No, there are no child care costs for either parent. Check this if neither parent pays for child care like daycare or a babysitter. Yes, the monthly child care costs for the child(ren) are: $________. Check this if a parent pays for child care, then fill in the monthly cost. Yes, the monthly child care costs for the child(ren) are: $________. Write how much is spent on child care each month. should be paid by me only Check this if you alone should pay the child care costs. the other parent only Check this if the other parent alone should pay the child care costs. both parents equally. Check this if both parents should split the child care costs equally.

e. Health & Medical Support

How should the children get medical support/insurance? (check one) Pick how the children will get health coverage: Medicaid, private/employer insurance, or another option you describe. The monthly premium should be paid by me only / the other parent only / both parents equally If you chose private or employer insurance, check who should pay the monthly cost: you, the other parent, or split equally. Other: If none of the choices fit, describe how the children should get medical coverage.