Fill and Sign the Modify Child Colorado Form

 District Court  Denver Juvenile Court _________________________________ County, Colorado Court Address: In re:  The Marriage of:  The Civil Union of:  Parental Responsibilities concerning: ______________________________________________________ Petitioner: and Co-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 Child Present Address Sex Date of Birth 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 3 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. 5. 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 change in the current Support Order is appropriate because of the following change(s) in circumstance(s). Please check the appropriate box.  Day Care costs  Change in Income  Change in Parenting Time  Change in Residence  Emancipation of a Child  Medical insurance coverage  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 Benefit Name of County or State 12. 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 2 of 3 I 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. 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 3