Free STATE OF WYOMING - Wyoming

STATE OF WYOMING COUNTY OF

) ) ss )

IN THE DISTRICT COURT JUDICIAL DISTRICT

, [Name] vs. , [Name] Respondent. Petitioner

) ) ) ) ) ) )

Civil Action No.

ORDER MODIFYING CHILD CUSTODY AND SUPPORT

THIS MATTER having come before the Court upon the Petition for Modification of Child Custody and Support; and by: [check one] Default (and Entry of Default has been issued) Stipulation/agreement of the parties (Both parties have signed the document) Hearing in Court/Trial The Court hereby FINDS: 1. An Order establishing custody and support was entered by the Court, District, State of ___________________,

case/docket number ________________ on the ___________ day of , 2. In the Order, ______ [year]. MOTHER MOTHER FATHER was granted custody of the parties' FATHER was ordered to pay $____________ per FATHER OR MOTHER and

minor child[ren] and

month in child support and

MOTHER OR

FATHER was/were ordered to provide medical insurance coverage. 3. Respondent was served with the Petition for Modification of Child Custody and

Support; [check one]: Personally on the following date in the following state:
CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 1 of 16

.

By publication. (Copy of Affidavit of Publication must be filed) Respondent accepted service (Acknowledgement and Acceptance of Service filed with court and Respondent's signature must be notarized). By Registered or Certified Mail (return receipt must be filed and Clerk must have entered certificate of service). 4. Respondent filed a response/answer a counter-petition/counterclaim (if so, did petitioner file a reply to counterclaim?) yes no no response (default must be entered, unless there is a waiver of right to answer) no response but both parties have signed and agreed to the entry of this Order.

5. A substantial and material change in circumstances exists and it is in the best interest of the child(ren) to modify custody. 6. CHILDREN AFFECTED BY THIS CASE: Full Name Current Address Date of Birth day/mo/yr

Place of Birth State

7. PRESUMPTIVE CHILD SUPPORT CALCULATION [See Instructions and Child Support Computation Form] A. In accordance with Wyo. Stat. §20-2-304, Monthly Presumptive Child Support for _____ [insert number] child(ren) is as follows: 1. Father's net monthly income is: $ 2. Mother's net monthly income is: 3. Total child support obligation of both parents is:
CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 2 of 16

$ $

4. Father's presumptive child support obligation is: 5. Mother's presumptive child support obligation is: B.

$ $

CHECK ONE: The child(ren) receive(s) means tested income; The child(ren) DO NOT receive(s) any means tested income.

8.

JUDGMENT OF ARREARS: [Check all the boxes that apply] MOTHER or FATHER owes back child support in the amount of $ from [Date of previous support order] through [Last day of the month before this Order is filed] for which judgment shall be entered; and/or MOTHER and/or FATHER owe(s) unpaid medical expenses in the amount of $ from [Date of the order establishing medical support] through [Last day of the month before this Order is filed], for which judgment shall be entered. IT IS HEREBY ORDERED THAT:

9. CUSTODY, VISITATION AND/OR PARENTING TIME: [Check the boxes that apply] A. BASIC PARENTING PLAN: (If this plan does not fit your situation, see B. (Other Parenting Plan) below OR G. (Supervised Visitation) below. A.1. Primary residential/physical custody FATHER OR MOTHER shall have the primary care, custody and control of the parties' minor child(ren). A.2. Weekend Parenting Time/Visitation The child(ren) shall spend time with FATHER every every other other (specify) to
(specify day of week & time)

MOTHER weekend from

(specify day of week & time)

A.3. Weekday Parenting Time/Visitation (If applicable) The child(ren) shall spend time with FATHER MOTHER during the week as follows: Specify days: A.4. Other Parenting Time/Visitation Schedule for Basic Parenting Plan: (specify)
CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 3 of 16

B.

OTHER PARENTING PLAN B.1 MOTHER: The child(ren) shall spend time with mother on the following days and times: WEEKENDS: From every every other to to
(specify time)

other (specify)
(specify day of week & time)

(specify day of week & time)

WEEKDAYS: Specify days: From
(specify time)

OTHER: (specify) B.2. FATHER: The child(ren) shall spend time with father on the following days and times: WEEKENDS: From every every other to to
(specify time)

other (specify)
(specify day of week & time)

(specify day of week & time)

WEEKDAYS: Specify days: From
(specify time)

OTHER: (specify) C. SUMMER SCHEDULE. (Choose one)

FATHER MOTHER shall have parenting time/visitation with the parties' child(ren) beginning ____________________ and continuing until __________________________ (i.e. Ten days after school lets out from 5:00 p.m. and continuing until ten days prior to school starting up again at 5:00 p.m.) AND SUMMER WEEKEND PARENTING TIME/VISITATION (If applicable) The child(ren) shall spend time with FATHER MOTHER every every other other (specify) weekend from to
(specify day of week & time) (specify day of week & time)

AND
CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 4 of 16

SUMMER WEEKDAY PARENTING TIME/VISITATION (If applicable) In the summer, the child(ren) shall spend time with FATHER MOTHER during the week as follows: Specify days: From
(specify time)

to
(specify time and day, if applicable)

OR The schedule during the summer will remain the same as during the school year; OR The schedule during the summer will remain the same as during the school year, except as follow: ______________________________________ ____________________________________________________________ _________________________________________________________________ OR OTHER SUMMER PARENTING TIME/VISITATION SCHEDULE (specify)

D. HOLIDAY SCHEDULE: The following holiday schedule will take priority over the regular weekday, weekend, and summer schedules described above. Fill in the boxes below to indicate where the child(ren) will be for the holidays. Provide beginning and ending times. If a holiday is not specified as even, odd, or every year with one parent, then the child(ren) will remain with the parent they are normally scheduled to be with. D. 1. SPRING VACATION (The weekday days of school Spring Break). CHOOSE ONE The child(ren) will alternate spending spring break with each parent, spending it with FATHER MOTHER in even years and with FATHER MOTHER in odd years. The child(ren) will spend part of spring break with each parent (provide details):

CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 5 of 16

Other spring break arrangements:

TIME & PLACE OF EXCHANGE From ______ a.m./p.m. the day after school lets out until ______a.m/p.m. the day prior to school beginning after the break. OTHER TIME & PLACE OF EXCHANGE:

TRANSPORTATION FATHER or MOTHER shall pick up the child(ren) from______________[insert location] at the beginning of the vacation and FATHER MOTHER shall pick up the child(ren) at the end of the vacation from ___________
(location)

OTHER TRANSPORTATION PLANS

D.2. CHRISTMAS (indicate either entire vacation period, half of the vacation period to each parent or other)
Parent spending time with child(ren) Odd numbered years Even numbered years First Half Second Half Entire Vacation period First Half Second Half Entire Vacation period All Years Beginning and Ending Time & Place of exchange

FATHER MOTHER FATHER MOTHER

First Half Second Half Entire Vacation period First Half Second Half Entire Vacation period

First Half Second Half Entire Vacation period First Half Second Half Entire Vacation period

TRANSPORTATION FATHER or MOTHER shall pick up the child(ren) from______________[insert location] at the beginning of the vacation and FATHER MOTHER shall pick up the child(ren) at the end of the vacation from
(location)

CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 6 of 16

OTHER TRANSPORTATION PLANS

D.3. OTHER HOLIDAYS (be very specific about dates or days, times and where exchanges are to going to take place and by whom)
Event Name of party spending time with child(ren) Odd numbered years (X) Even numbered years (X) All Years Time & Place of exchange

Mother's Day Memorial Day Father's Day July 4th Labor Day Thanksgiving Break Thanksgiving Day Winter Break Child(ren)'s Birthdays Religious Events Other Holiday Events

E. PRIORITY: The following priorities shall apply to the parenting/visitation schedule: When parents are using an alternating weekend plan and the holiday schedule would result in one parent having the child(ren) for three weekends in a row, the alternating weekend pattern will restart so neither parent will go without having the child(ren) for more than two weekends in a row. If a parent has the child(ren) on a weekend with an unspecified holiday or non-school day attached, they shall have the child(ren) for the holiday or nonschool day.
CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 7 of 16

Other:_______________________________________________

F. TEMPORARY CHANGES TO THE SCHEDULE. Any schedule for sharing time with the child(ren) may be changed as long as both parents agree to the changes ahead of time: in writing; by speaking to each other (choose one). Activities scheduled that will affect the other parent's time must be coordinated with the other parent. Makeup and Missed Parenting Time: Only substantial medical reasons will be considered sufficient for postponement of parenting time. If a child is ill and unable to spend time with a parent, a makeup parenting time will be scheduled. If a parent fails to have the child(ren) during their scheduled parenting time for any other reason, there will be no makeup of parenting time unless the parents agree otherwise: in writing by speaking to each other (choose one). G. SUPERVISED OR NO VISITATION (Check and complete only if supervised or no visitation is ordered): G.1. The father mother shall have no visitation with the minor child(ren) and this is best for the child(ren) for the following reasons: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ OR G.2. The father mother shall have supervised visitation with the minor child(ren) for the following reasons: ____________________________________________________________ ______ Visitation may only take place in the presence of another person as listed below or as otherwise approved by the Court. Name of Supervisor: ___________________________________________________________ Visitation shall occur on the following days/times: __________________________________________________________________ __________________________________________________________________ ________________________________________________

CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 8 of 16

The cost of supervised visitation will be paid by shared equally. 10.

father

mother OR

PERMANENT CHANGES TO THE SCHEDULE. Once the judge signs this Order, any changes that the parents do not agree on can be made only by applying to the court for a modification. One parent cannot change a court-ordered Parenting Plan or Visitation Schedule on their own. PARENT-CHILD COMMUNICATION Both parents and child(ren) shall have the right to communicate by telephone, in writing or by e-mailing during reasonable hours without interference or monitoring by the other parent. Procedures for telephone, written, or e-mail access (describe ground rules for parent-child communication):

11.

Other:

12. MUTUAL RESPECT. Parents will not say things or knowingly allow others to say things in the presence of their child(ren) that would take away the child(ren)'s love and respect for the other parent. 13. ACCESS TO RECORDS. Unless otherwise ordered by the court, the law provides that both parties have access to the records of the child(ren) including school records, activities, teachers and teachers' conferences as well as medical and dental treatment providers and mental health records, unless access is limited by the Court. OTHER: If you believe that there are valid reasons to limit the other party's access to records, you must ask the Court to limit access and obtain an order that does so. (Wyo. Stat. §20-2-201(e)).

14.

OTHER TERMS Add any other items regarding the child(ren) you would like to include in your Parenting Plan. Use additional sheets if necessary. __________________________________________________________________

Additional sheets of paper are attached. 15. EXCHANGE OF CHILD(REN):

CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 9 of 16

Both parents shall have the child(ren) ready on time with sufficient clothing packed and ready at the agreed-upon time of exchange. All clothing that accompanied the child(ren) shall be returned to the other parent, unless the parents otherwise agree. Unless otherwise stated above, if both parents reside in the same county (or within a reasonable distance of each other), both parents shall share equally in the responsibility of exchanging their child(ren) from one parent to the other. Other: (provide details for the exchange of the child(ren)):

16. FUTURE CONFLICT RESOLUTION. If the parents cannot reach an agreement in the future on any issue involving the parenting plan, they agree do not agree to enter into mediation. Any costs of mediation (or other alternative dispute resolution) shall be paid _______ % by _____________________________________________(name of party) and _______% by ______________________________________ (name of party). If the mediation fails, the final decision will be made by the Court. ONCE FILED, The parties may make substantial, permanent modifications to this Parenting Plan only by written agreement signed by both parties, APPROVED BY THE JUDGE and filed with the Court. Minor, non-permanent changes may be made any time IF both parties agree to the changes. 17. CHILD SUPPORT ISSUES: A. JUDGMENT: Judgment for past due support, including medical support if applicable, is hereby entered against FATHER or MOTHER in the amount of $ through [Date]. B. PAYMENT OF JUDGMENT: Beginning [Date], FATHER or MOTHER shall pay $ per month in addition to current support towards the judgment of $ [total amount of judgment listed in paragraph 8] until the judgment is paid and satisfied in full. C. FUTURE CHILD SUPPORT: Child support shall continue during the minor child's minority, and beyond if the child has a mental, emotional or physical impairment preventing emancipation, or while the child is attending high school or an equivalent program as a full-time student between the ages of 18 and
CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 10 of 16

D. TERMINATION OF CHILD SUPPORT: Child support shall terminate if, during the child's minority, the child marries, is emancipated, becomes selfsupporting or dies. E. AMOUNT OF CHILD SUPPORT: Mother or Father shall pay $ per month for the current support of the minor child(ren) listed in paragraph 60 beginning [Date]. (See "The Steps" section for retroactive modification.) The support obligation shall be paid on the same day of each month thereafter until termination of the support order. F. WHERE TO MAKE CHILD SUPPORT PAYMENT: All child support payments shall be paid to the Clerk of District Court, whose address is:______________________________ (See District Court Clerks' Addresses in the packet). The Clerk shall forward the support payments to the receiving parent at the address provided by that parent to the Clerk. Payments must be made with cashier's checks and money orders unless the Clerk otherwise informs you. G. ABATEMENT (TEMPORARY RELIEF FROM PAYING CHILD SUPPORT): Child support may abate or decrease by one-half (1/2) of the daily support obligation for each day the non-custodial parent has physical custody of the child for whom support is due, ONLY IF the non-custodial parent has custody of the child for more than fifteen (15) consecutive days and if approved by the Court. REQUIREMENTS: 1. The non-custodial parent MUST FILE any claim for child support abatement with the clerk of the court within thirty (30) days after the period for which abatement is claimed and must pay ten dollars ($10.00) to the clerk when filed. 2. The clerk will then mail a copy of the claim to the custodial parent. 3. The custodial parent can object or dispute any abatement claim by filing an objection with the clerk of court within thirty (30) days of the date the clerk mailed the notice to the custodial parent and paying ten dollars ($ 10.00) to the clerk. 4. The clerk will mail a copy of the objection to the non-custodial parent. 5. Claims or objections not filed in a timely manner or not accompanied by the ten dollar fee will be rejected.

CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 11 of 16

18. MEDICAL INSURANCE PAYMENTS AND EXPENSES: Either or both of the parents shall provide medical support, which may include dental, optical or other health care needs for their dependent children as follows: A. Mother or Father OR both parents are/is ordered to provide medical insurance for the minor child(ren). (It is important to understand that both parents have an obligation to ensure that their child or children have medical insurance coverage even if the state is currently providing such coverage, either or both parents may be required to pay the state back for the expenses incurred in providing medical insurance coverage for the child or children.) B. The party or parties ordered to provide insurance shall submit to the court and to the other parent or the other parent's representative written proof that the insurance has been obtained or that application for insurability has been made within sixty (60) days of entry of this Order. C. Proof of insurance coverage shall contain, at a minimum: (i) The name of the insurer; (ii) The policy number; (iii) The address to which all claims should be mailed; (iv) A description of any restrictions on usage, such as pre-approval for hospital admission, and the manner in which to obtain pre-approval; (v) A description of all deductibles; and (vi) Two (2) copies of claim forms. D. INSURANCE INFORMATION: The obligated parent(s) shall provide written notice to the clerk of this court and to the other parent if insurance coverage for any child is denied, revoked, or altered in any way that would affect the other parent (i.e. change to child's coverage, including any change relating to the information required above). E. UNCOVERED MEDICAL EXPENSES: The parties shall pay any noncovered expenses of medical, dental, orthodontic and optical care that is not covered by insurance; the Mother paying ______% of uncovered expenses and Father paying ______% of uncovered expenses including co-payments and deductibles. F. CHANGES TO INSURANCE: The obligated parent(s) shall provide written notice to the clerk of this court and to the other parent if insurance coverage for any child is denied, revoked or altered in any way that would affect the child's coverage including any change relating to the information required in Paragraph 20.C. in compliance with Wyo. Stat. §20-2-401(c). 19. ENFORCEMENT: Either party has the right to petition to enforce an order pursuant to Wyo. Stat. §20-2-310, including asking the court to enforce and require future compliance with an order, by finding the obligated parent to be in contempt of court, award attorney fees, costs and any other relief as the court may deem necessary under the
CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 12 of 16

circumstances. Wyoming law (Wyo. Stat. §1-16-102(c)) states that any payment of child support not paid when due shall automatically become a judgment against the parent who is supposed to pay on the due date. Any child support which is not paid within thirty-two (32) calendar days from the date due is subject to an automatic late payment penalty in an amount equal to ten percent (10%) of the amount of the judgment by operation of law. 20. TAX EXEMPTION: The parties shall claim as income tax dependency exemptions on federal and state tax returns as follows. A party required to pay child support is only entitled to claim a child(ren) as an income tax dependency exemption if that parent has paid all of the child support due and owing for the year that party is entitled to the exemption: Name of child Parent entitled to claim mother father mother mother mother father father father Year Allowed to Claim every odd even Other: ______ every odd Other: ______ every odd Other: ______ every odd Other: ______ even even even

21. CHANGE OF EMPLOYMENT OR ADDRESS: Each parent shall inform the other parent and the clerk of court in writing of any change of address, phone number, and employment: A. CHANGE OF EMPLOYMENT STATUS - so long as there is a child support obligation, each parent shall notify the other parent and the Clerk of this Court, in writing, on forms available from the Court, within fifteen (15) days of any change in employment, including second jobs, changed employers, starting or ending unemployment compensation, and starting or ending of worker's compensation, or any other change in income. B. CHANGE OF ADDRESS ­ so long as there is a child support obligation, if either parent plans to change his or her address, that parent must notify the other parent and the clerk of this court, in writing, on forms available from the Clerk of this Court, no later than fifteen (15) days prior to the day of the move, the destination of the move and the proposed move date. C. CHANGE OF HOME CITY OR STATE OF RESIDENCE - either parent who plans to change their home city or state of residence, must give written notice thirty (30) days prior to the move, both to the other
CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 13 of 16

parent and to the clerk of district court stating the date and destination of the move. 22. INCOME WITHHOLDING ORDER: Upon entry or modification of any support order, the court shall also enter an income withholding order which shall take effect immediately, unless the parties agree otherwise, or unless one (1) of the parties demonstrates, and the court finds, that there is good cause not to require immediate income withholding. When the parties agree to an alternative arrangement, the arrangement shall be in writing, signed by the parties and reviewed and entered in the record by the court. IMMEDIATE ENTRY (Recommended); OR NOT IMMEDIATE ENTRY. If an Income Withholding Order is not immediately effective, one will become effective upon the earliest of the following (1) The date the obligor requests withholding commence; or (2) The date the obligor becomes delinquent in payment of an amount equal to one (1) month's support obligation under the support order. If there is not to be an immediate Income Withholding Order, the court shall include in the record its findings of good cause, including a statement explaining why implementation of immediate income withholding would not be in the best interests of the child and, in cases involving modification of child support, proof of timely payments: __________________________________________________________________ 23. REQUIRED INFORMATION: The MOTHER'S NAME ADDRESS DATE OF BIRTH PLACE OF BIRTH EMPLOYER'S NAME EMPLOYER'S ADDRESS The FATHER's NAME ADDRESS DATE OF BIRTH PLACE OF BIRTH EMPLOYER'S NAME EMPLOYER'S ADDRESS
CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 14 of 16

24. Either party or, when appropriate, the department of family services has the right to petition to enforce an order. See Wyo. Stat. §20-2-310. 25. Any provision of the previous support order not specifically addressed or modified herein shall remain in full force and effect. SO ORDERED this day of , 20 .

DISTRICT COURT JUDGE

If the parties have agreed: I certify that I have read the foregoing ORDER MODIFYING CHILD CUSTODY AND SUPPORT and that I agree to the terms and agree to entry of the Decree of Divorce. _______________________________ Petitioner's signature ______________________________ Respondent's signature

I certify that I have read the foregoing ORDER MODIFYING CHILD CUSTODY AND SUPPORT and that I understand and agree to the terms and agree to the entry of this Order. __________________________ Petitioner's Signature STATE OF ______________________ ) ) ss COUNTY OF ____________________ ) Subscribed and sworn to before me by _________________________________, this ______ day of _____________________, ______. Witness my hand and official seal ______________________________ Notary Public/Clerk of Court My Commission Expires: __________________________ (Respondent's signature) STATE OF _____________________ ) ) ss COUNTY OF ___________________ ) Subscribed and sworn to before me by _________________________________, this ______ day of _____________________, ______. Witness my hand and official seal: ______________________________ Notary Public/Clerk of Court
CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 15 of 16

My Commission Expires APPROVED AS TO FORM:

_______________________________ Petitioner's signature

______________________________ Respondent's signature

If default has been entered and the Respondent did not respond: The above is true and accurate and I want the court to approve: ______________________________ Signature of Petitioner

CCMod 17 Order Modifying Child Custody and Support Revised September 2007 Page 16 of 16