Free ______________________County, Colorado District Court - Colorado

District Court Denver Juvenile Court _________________________________ County, Colorado Court Address: In re: The Marriage of: Parental Responsibilities concerning: ______________________________________________________ Petitioner: and Co-Petitioner/Respondent: Attorney or Party Without Attorney (Name and Address):

COURT USE ONLY Case Number:

Phone Number: FAX Number:

E-mail: Atty. Reg.#:

Division

Courtroom

VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO §14-10-122, C.R.S.

Note to Responding Party: If you disagree with this Motion, the Colorado Rules of Civil Procedure allow you to file a written response with the Court which must be filed within 15 days of the date this Motion was served on you or mailed to you.

The

Petitioner

Co-Petitioner/Respondent states the following for the purpose of modifying child support. Date of Birth: __________________________

1. Information about Petitioner:

Current Mailing Address: __________________________________________________________________ City & Zip: ______________________________________________________________________________ Home Phone #: ___________________ Work Phone #: __________________ Cell #: __________________

2. Information about Co-Petitioner/Respondent:

Date of Birth: __________________________

Current mailing address: ___________________________________________________________________ City & Zip: ______________________________________________________________________________ Home Phone #: ___________________ Work Phone #: ___________________ Cell #: _________________

3. The parties have ______ minor child(ren):
Full Name of Child Present Address Sex Date of Birth

4. Under the current Support Order, the Petitioner has________ overnights per year with the children and the
Co-Petitioner/Respondent has ________ overnights per year with the children.

JDF 1403

R7/07

VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO §14-10-122, C.R.S.

Page 1 of 3

5. Under the current child support order, the
obligation is $ _________and is paid weekly

Petitioner's bi-weekly

Co-Petitioner's/Respondent's child support twice a month monthly Other: ________.

6.

(Check only if applicable.) The current support order does not contain a provision regarding medical insurance (medial, dental, and/or vision) coverage.

7. A change in the current Support Order is appropriate because of the following change(s) in circumstance(s).
Please check the appropriate box. Change in Parenting Time Medical insurance coverage Day Care costs Change in Residence Change in Income Emancipation of a Child

Other: ______________________________________________________

Describe why you are requesting the modification.

8. The new child support obligation that I am requesting
bi-weekly twice a month monthly

is

is not more than a 10% change from the current weekly

child support order. The proposed child support obligation should be $____________ to be paid Other: ________.

9. I/We have completed a child support worksheet that shows what the new child support obligation should be.
The child support worksheet is is not attached to this Motion.

10. I/We have attached current Sworn Financial Statements to this Motion. 11. Is either party currently receiving public assistance?
Name of Person Receiving Benefit Yes No If you checked Yes, answer the following:

Name of County or State

12. Is either party receiving child support enforcement services.

Yes ____________________________ (County) ______________________ (State).

No

If

Yes,

identify

13. Does either parent live in another state?
JDF 1403 R7/07

Yes No If Yes, identify __________________________ (name of person) and ___________________________________ (City and State) they are currently living in.
VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO §14-10-122, C.R.S. Page 2 of 3

14.

(Check only if applicable.) I request a change in the current tax exemption because of the reallocation of the costs of raising the dependent children, pursuant to §14-10-115(12), C.R.S. Petitioner's Co-Petitioner's/Respondent's

I respectfully request that this Court enter an Order modifying the child support obligation as described above.

VERIFICATION AND ACKNOWLEDGMENT
I swear/affirm under oath that I have read the foregoing Motion and that the statements set forth therein are true and correct to the best of my knowledge.

_____________________________________ Signature of Attorney, if applicable Date

____________________________________________ Petitioner or Co-Petitioner/Respondent ____________________________________________ Address ____________________________________________ City, State, Zip Code ____________________________________________ (Area Code) Telephone Number (home) ____________________________________________ (Area Code) Telephone Number (work)

Subscribed and affirmed, or sworn to before me in the County of ______________________, State of __________________, this ___________ day of _______________, 20______.

My Commission Expires: ___________________

____________________________________________ Notary Public/Deputy Clerk

CERTIFICATE OF SERVICE
I certify that on ________________________ (date) a true and accurate copy of the Verified Motion to Modify Child Support was served on the other party by: Hand Delivery, E-filed, Faxed to this number: _______________________, or by placing it in the United States mail, postage pre-paid, and addressed to the following: To: _______________________________________ _______________________________________ _______________________________________ ______________________________________
Your signature

If the Child Support Enforcement Unit is involved in the case, you must provide them a copy of this Motion.

JDF 1403

R7/07

VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO §14-10-122, C.R.S.

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