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Nebraska State Court Form COMPLAINT FOR MODIFICATION OF CHILD SUPPORT (INCREASE) DC 6:14.5 Rev. 06/2019 Neb. Rev. Stat. § 42-364, Neb. Ct. R. § 4-217 IN THE DISTRICT COURT OF ___________________COUNTY, NEBRASKA (county where the original action was filed) __________________________, (name of plaintiff in original action) Plaintiff, vs. Case No. CI ___________________________ (case number in original action) COMPLAINT FOR MODIFICATION OF CHILD SUPPORT (INCREASE) __________________________, __________________________, (name of the defendant(s) in original action) Defendant(s). I, ___________________________, without the assistance of an attorney, state that the (your full name) following is true: 1. On __________________________ the court ordered ____________________________ (date of the most recent order setting child support) (name of payor) to pay child support for the below listed child(ren): _____________________________, born ___________________ (name of child) (child’s year of birth) (name of child) (child’s year of birth) (name of child) (child’s year of birth) (name of child) (child’s year of birth) _____________________________, born ___________________ _____________________________, born ___________________ _____________________________, born ___________________ Additional children are listed on a separate page. Pursuant to the Nebraska Child Support Guidelines, child support payments were to begin on the 1st day of ______________________________________, and continue (month and year the most recent order setting child support became effective) on the first day of each subsequent month thereafter in the amounts set forth: ____________ per month for ________ children (support amount) (number of children) ____________ per month for ________ children (support amount) (number of children) ____________ per month for ________ children (support amount) (number of children) ____________ per month for one child (support amount) Page 1 of 2 Complaint for Modification Child Support (increase) DC 6:14.5 Rev. 06/2019 2. There has been a material change in circumstances since the date the Order was entered. 3. __________________________ is eligible for a Modification of the Child Support Order (name of payee) within the meaning of the Nebraska Child Support Guidelines and Nebraska Statutes. 4. Application of the Nebraska Child Support Guidelines to the party(ies) current income would increase the monthly child support obligation by 10% or more, and by not less than $25 per month. 5. The material change in the party(ies) circumstances since the date of the most recent order setting child support is as follows: Check All That Apply ___________________________’s employment income has substantially increased. (name of party) ___________________________’s employment income has substantially decreased. (name of party) 6. The change in the party(ies) financial circumstances has lasted for three months and can reasonably be expected to last for an additional six months. WHEREFORE, I ask that this court modify the child support obligation entered on __________________________________, and increase the monthly child support obligation (date of the most recent order setting child support) to an amount consistent with the Nebraska Child Support Guidelines, and for such other relief as the court deems appropriate. Signature Date Name Street Address/P.O. Box E-mail Address City/State/ZIP Code Phone Page 2 of 2 Complaint for Modification Child Support (increase) DC 6:14.5 Rev. 06/2019