Free Petition for Expedited Modification of Child Support - West Virginia

IN THE FAMILY CO URT OF ________________ COUNTY, WEST VIRGINIA. In Re: The Marriage / Children of: _________________________, Petitioner _________________________ _________________________
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Civil Action No. ____________ and _________________________. Respondent _________________________ _________________________
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PETITION FOR EXPEDITED MODIFICATION OF CHILD SUPPORT 1. GENERAL INFORMATION
a. The Petitioner is: ________________________, who is:
(Print your name.)

___ the mother / wife whose name is listed in the case style at the top of this page. ___ the father / husband whose name is listed in the case style at the top of this page. ___ other person, whose relationship to the Respondent and children is: ________________ ______________________________________________________________________. b. The Petitioner requests that the Order entered on the date of ________________________ be modified with regard to child support. The Petitioner wants child support: ___ Increased ___ Decreased

2. CHANGES IN PETITIONER'S FINANCIAL CIRCUMSTANCES
All changes must have occurred after the date of the Order you want modified. Income ___ ___ ___ Petitioner's gross income has increased from $ ________ per month to $ ________ per month. Petitioner's gross income has decreased from $ ________ per month to $ ________ per month. Petitioner's gross income has not changed.

If your income has changed, you must explain why it changed: ______________________ ___________________________________________________________________________ ___________________________________________________________________________

SCA -FC-22 6 (12/01)

Petition for Expedited M odification of Ch ild Supp ort

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If you have pay stubs or other documents that show the change in your income, you should attach copies to this Petition. ___ I have not attached any documents. ___ I have attached documents, which are: ________________________________________ ___________________________________________________________________________ Child Care Costs ___ Petitioner pays child care costs to be able to work; and after the date of the Order Petitioner wants modified, those costs have: ___ increased from $ ________ per month to $ ________ per month; ___ decreased from $ ________ per month to $ ________ per month; ___ remained the same.

Extraordinary Medical Expenses ___ Petitioner has incurred extraordinary medical expense after the date of the Order Petitioner wants modified. If you checked this item, you MUST list the amounts and dates for these expenses, and the reasons they were incurred. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Other Changes In Financial Circumstances Explain in detail any other changes in your financial circumstances. Examples of such changes are: changes in the number of dependent children you support; cost of health insurance coverage; cost of housing. All changes must have occurred after the date of the Order you want modified. ______________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

3. CHANGES IN THE OTHER PARENT'S FINANCIAL CIRCUMSTANCES
All changes must have occurred after the date of the Order you want modified. Income ___ ___ The other parent's gross income has increased from $ ________ per month to $ ________ per month. The other parent's gross income has decreased from $ ________ per month to $ ________ per month.

SCA -FC-22 6 (12/01)

Petition for Expedited M odification of Ch ild Supp ort

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___

The other parent's gross income has not changed.

If the other parent's income has changed, explain why it changed: ______________________ ___________________________________________________________________________ ___________________________________________________________________________ If you have pay stubs or other documents that show the change in the other parent's income, you should attach copies to this Petition. ___ I have not attached any documents. ___ I have attached documents, which are: _______________________________________________________________________ ___________________________________________________________________________ Child Care Costs ___ The other parent pays child care costs to be able to work; and after the date of the Order Petitioner wants modified, those costs have: ___ increased from $ ________ per month to $ ________ per month; ___ decreased from $ ________ per month to $ ________ per month; ___ remained the same.

Extraordinary Medical Expenses ___ The other parent has incurred extraordinary medical expense after the date of the Order Petitioner wants modified. If you checked this item, you MUST list the amounts and dates for these expenses, and the reasons they were incurred. __________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Other Changes In Financial Circumstances Explain in detail any other changes in the other parent's financial circumstances. Examples of such changes are: changes in the number of dependent children he / she supports; cost of health insurance coverage; cost of housing. All changes must have occurred after the date of the Order you want modified. _________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

4. CHILDREN
SCA -FC-22 6 (12/01) Petition for Expedited M odification of Ch ild Supp ort Page 3 of 4

List the name, date of birth, social security number, and address for all of the children for whom support is paid under the Order you want modified. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

_________________________________ Petitioner's Signature

___________________ Date

You must sign the following Verification before a Notary Public or Deputy Circuit Clerk. VERIFICATION I, ____________________________, after making an oath or affirmation to tell the truth, say that the facts I have stated in this Petition are true of my personal knowledge; and if I have set forth matters upon information given to me by others, I believe that information to be true. ___________________________ Signature ___________________ Date

This Verification was sworn to or affirmed before me on the ____ day of __________________, 20____.

_________________________
Notary Public / Other official My commission expires:______________________.

SCA -FC-22 6 (12/01)

Petition for Expedited M odification of Ch ild Supp ort

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