Free STATE OF WYOMING - Wyoming

STATE OF WYOMING COUNTY OF [Name] vs. Petitioner

) ) ss ) , ) ) ) ) ) ) )

IN THE DISTRICT COURT JUDICIAL DISTRICT

Civil Action No.

, [Name] Respondent.

PETITION TO MODIFY CHILD CUSTODY AND SUPPORT Petitioner, respectfully requests this Court modify an order regarding child custody and support, and, if applicable, enter a judgment for arrears/back child support. In support of this petition, the petitioner states the following: 1. Petitioner is the [Check the appropriate box] custodial parent; or non-custodial parent and is a resident of 2. [Check the appropriate box] A child custody and support order was entered on [date] by this Court; or A child custody and support order was entered on by the Court, County, State of . [date] County, [State].

3. CHILD CUSTODY JURISDICTION: This court made the original child custody determination and has exclusive, continuing jurisdiction to modify the order concerning the care, custody and visitation of the children. The child, the child's parents or any person acting as a parent presently reside in this state. (If this court did not enter the original order or if neither party or the child(ren) continues to reside in this state, seek the advice of an attorney.) 4. REQUIRED INFORMATION FOR CHILDREN: The following information is required for each child, unless you have a court order or are operating under another law allowing you to maintain confidentiality of addresses or other identifying
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information. If the information in paragraphs 5 through 8 is not furnished, the court, upon motion of a party or its own motion, may stay the proceeding until the information is furnished. (Attach a separate sheet, if necessary.) Child's name: Birth date: Place of birth: Present address: Name(s) of person(s) with whom child/ren lived during the past 5 years Beginning Date Ending Date Present address of person(s) with whom child(ren) lived during this period

Child's name: Birth date: Place of birth: Present address: Name(s) of person(s) with whom child/ren lived during the past 5 years Beginning Date Ending Date Present address of person(s) with whom child(ren) lived during this period

Child's name: Birth date: Place of birth: Present address: Name(s) of person(s) with whom child/ren lived during the past 5 years Beginning Date Ending Date Present address of person(s) with whom child(ren) lived during this period

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Child's name: Birth date: Place of birth: Present address: Name(s) of person(s) with whom child/ren lived during the past 5 years Beginning Date Ending Date Present address of person(s) with whom child(ren) lived during this period

5. OTHER CASES INVOLVING CHILD(REN): State whether you have participated as a party or witness or in any capacity in any other proceeding (court cases) concerning the custody, allocation of decision-making, or visitation/parenting time of any of the children listed in this Petition in this or any other state: (If yes, please be specific regarding case number, court, state and nature of case, date of child-custody determination, if any, and child(ren)'s name(s)):

6. OTHER PROCEEDINGS, INCLUDING PROTECTION ORDERS: State whether you have any information of any custody proceeding that could affect the current proceeding, including proceedings for enforcement and civil and criminal proceedings relating to domestic violence, protective orders, termination of parental rights and adoptions, and if so, identify the court, the state, the case number and the nature of the proceeding and child(ren)'s name(s):

CUSTODY AND VISITATION RIGHTS OF OTHERS: The following 7. people are not parties in this matter, but have physical custody of the child(ren) or claim rights of parental responsibilities, legal custody or physical custody, or visitation/parenting time with the child(ren) (names and addresses of those persons): ________________________________________________________________________ ________________________________________________________________________ 8. The Order listed in Paragraph 2: [Check the appropriate box] Has not been modified in this state or any other state with respect to child custody and child support;
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Was last modified with respect to the child custody and/or child support obligations by this Court on [date]; or Was last modified with respect to the child custody and/or child support obligations by order of the Court, County, State of , on [date]. 10. Attached is a certified copy of the custody order to be modified as required by Wyo. Stat. §20-2-203(c). According to the terms of the most recent court order, custody and visitation was ordered as follows:

11.

If child support was also ordered, according to the terms of the most recent court order: [Check the appropriate boxes for each section] A. The non-custodial parent is required to pay $ per month in child support for the parties' minor child(ren) named in paragraph 3. The noncustodial parent is [Check one box] in arrears (owes back child support). (A copy of the record of child support payments certified as a true copy of the original by the custodian of the record [Clerk of District Court or Child Support Enforcement] may be attached and/or forwarded to the court. The copy is evidence of facts asserted in it, and is admissible to show whether payments were made. Wyo. Stat. §20-4-166(c)). If applicable, the amount of arrears is $ through the date of the filing of this Petition. A judgment should be entered against the non-custodial parent for this amount and any additional amounts which may accrue prior to entry of an order in this action. current (not in arrears) for the child support obligation. B. The custodial non-custodial parent is required to provide medical insurance for the child(ren). Such insurance has has not been provided as ordered. C. The non-custodial parent was required not required to pay for a percentage of medical expenses not covered by insurance. Such medical expenses have have not been paid as ordered. If the non-custodial parent has not paid

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medical expenses as ordered, the total amount owed is $ through the date of the filing of this Petition (attach copies of bills/receipts, if available). A judgment should be entered against the non-custodial parent for this amount and any additional amounts that are owed prior to entry of an order in this action. D. Neither party has been ordered to provide medical insurance. Petitioner is requesting this Court order [Name] to provide medical insurance and that all medical expenses not covered % to be paid by by insurance be divided in the following manner: Mother and % to be paid by Father. 12. Reason for seeking modification of child custody. Since the date of the last order, a material change in circumstances has occurred which warrants modifying the child custody and/or child support obligations. The change in circumstances is: [Please describe]

_______________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________
13. That because of the substantial and material change in circumstances, it is in the best interests of the child(ren) to have the following custody/visitation arrangements: ______________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ THEREFORE, Petitioner respectfully requests: 1. 2. 3. The Court set a hearing on the Petition to Modify Child Custody and Support; The parties be ordered to complete and file Confidential Financial Affidavits as provided by Wyo. Stat. § 20-2-308; The Court review and modify the child custody to an arrangement in the best interests of the child(ren);

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4. 5. 6. 7.

The Court review and modify the child support order to an amount consistent with the Wyoming Child Support Guidelines; The Court review and modify the medical insurance obligation and the allocation of costs not covered by medical insurance, if requested. If applicable, the Court enter a judgment for child support arrears and for unpaid medical expenses not covered by medical insurance. Other:

8.

For such other and further relief as the Court deems necessary and just. day of Petitioner [Signature] Print Name, Address & Phone Number: , 20 . ,

DATED this

STATE OF COUNTY OF

) ) ss. ) , 20 .

Subscribed and sworn to before me by , this day of Witness my hand and official seal.

Notary Public/Clerk of Court My commission expires: Pursuant to Rule 102(a)(1)(B) of the Wyoming Uniform Rules of District Court, the following attorney has participated in the preparation of this pleading, but this attorney is NOT deemed to have entered an appearance in this matter: Attorney's Name, Address and Phone Number:
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