Fill and Sign the District Court Colorado Divorce and Mediation Form

JDF 1403 R8-17 VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO §14-10-122, C.R.S. © 2017 Colorado Judicial Department for use in the Courts of Colorado Page 1 of 3District Court Denver Juvenile Court _________________________________ County, ColoradoCourt Address:In re:The Marriage of:The Civil Union of: Parental Responsibilities concerning:______________________________________________________Petitioner:andCo-Petitioner/Respondent: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail:FAX Number: Atty. Reg.#:Case Number:Division Courtroom 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 21 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.1.Information about Petitioner: Date of Birth: __________________________ 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 ChildPresent AddressSexDate of Birth4. 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 R8-17 VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO §14-10-122, C.R.S. © 2017 Colorado Judicial Department for use in the Courts of Colorado Page 2 of 35. Under the current child support order, the Petitioner’s Co-Petitioner’s/Respondent’s child support obligation is $ _________and is paid weekly bi-weekly 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 c h a nge in t h e c u rre nt S up port O rd er is a ppro pria te b eca use o f t h e f o llo w in g c h ange (s ) in c ir c u m sta nce (s ). Please check the appropriate box. Day Care costs Change in Income Change in Parenting Time Change in Residence Em ancip atio n o f a C hild  Medic a l in su ra nce c o ve ra ge  Other: ______________________________________________________ Describe why you are requesting the modification.8. The new child support obligation that I am requesting is  is not more than a 10% change from the current child support order. The proposed child support obligation should be $____________ to be paid  weekly bi-weekly  twice a month monthly 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?  Yes  No If you checked Yes, answer the following:Name of Person Receiving BenefitName of County or State12. Is either party receiving child support enforcement services. Yes No If Yes, identify ____________________________ (County) ______________________ (State).13.Does either parent live in another state? Yes No If Yes, identify __________________________ (name of person) and ___________________________________ (City and State) they are currently living in. 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. JDF 1403 R8-17 VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO §14-10-122, C.R.S. © 2017 Colorado Judicial Department for use in the Courts of Colorado Page 3 of 3I respectfully request that this Court enter an Order modifying the Petitioner’s Co-Petitioner’s/Respondent’s child support obligation as described above. By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form.(Checking this box requires you to remove JDF number and copyright at the bottom of the form.) VERIFICATION AND ACKNOWLEDGMENT I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct.Executed on the ______ day of ________________, _______, at ______________________________________ (date) (month) (year) (city or other location, and state OR country_____________________________________ ____________________________________________(printed name of Petitioner or Co-Petitioner/Respondent) Signature of Petitioner or Co-Petitioner/Respondent ____________________________________________Address____________________________________________City, State, Zip Code____________________________________________(Area Code) Telephone Number (home)____________________________________________(Area Code) Telephone Number (work) 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.