Fill and Sign the Modify Divorce Decree Form

IN THE _______________ (Name of Court) OF _________________ (Name of County), _____________________ (Name of State) _____________________________ PETITIONER (Name of Petitioner) VS. CASE NUMBER _____ ____ ____________________________ RESPONDENT (Name of Respondent) Department of Human Services State of _____________________ (Name of State) v. CASE NUMBER _________ ______________________________ (Name of Parent Paying Child Support) Joint Petition to Modify Divorce Decree of Father Agreeing to be Sole Provider of Child Comes now ___________________ (Name of Mother) , and ___________________ (Name of Father) , and petitions the court for an order modifying the Decree filed in this action on ____________________ (Date of Divorce and/or Support Decree) , by terminating the child-support and medical expense payments presently being paid on behalf of their son/daughter ___________________ (Name of Son/Daughter) , (hereafter referred to as Son or Daughter ) and in support of this Petition would show unto this Honorable Court the following matters and facts, to-wit: 1. ____________________ (Name of Son/Daughter) , the minor child of the former marriage of Petitioners, will turn _______ (age) in _____________ (month) of this year; his/her date of birth being _________________ (date of birth) . Son/Daughter is not going to school and no longer lives at home in ________________________ ( Name of County and State ) , with his/her mother nor does she live with her father. He/She recently moved to ____________ _____________ ( Name of City and State ) and lives on his/her on. 2. Petitioners __________________ (Name of Mother) , and ____________________ (Name of Father) are concerned that if _____________________ (Name of Son/Daughter) ’s, child support, which amounts to $__________ per month, is not terminated, he/she will continue to do nothing as far as getting a job or going to school. 1 WHEREFORE, PREMISES CONSIDERED, Petitioners pray that on hearing of this Petition, that this Honorable Court would enter an Order terminating the responsibility of Petitioner ____________________ (Name of Father) to pay child support, maintain a major medical insurance policy covering Son/Daughter, and/or be responsible for or required to pay Son’s/Daughter’s dental, hospital and/or prescription drugs. And if Petitioners have prayed for wrong and improper relief, then they pray for such other, further and general relief as they may be entitled to in the premises, and as in duty bound, they will ever pray. Respectfully submitted, _________________________ (Name of Father) _________________________ (Name of Mother) STATE OF ______________ COUNTY OF ______________ Personally appeared before me, the undersigned authority in and for the aforesaid jurisdiction, the within named __________________ (Name of Father) , who, after having been first duly sworn, stated on oath that the matters and facts set forth in the above and foregoing Petition are true and correct as therein stated. ___________________________ ___________________________ (Name & Signature of Father) SWORN to and subscribed before me, this the ________ day of ________________, 20____ (Date) . . ____________________________ Notary Public My Commission Expires: ________________________ 2 STATE OF ____________________ COUNTY OF ______________ Personally appeared before me, the undersigned authority in and for the aforesaid jurisdiction, the within named _________________ (Name of Mother) , who, after having been first duly sworn, stated on oath that the matters and facts set forth in the above and foregoing Petition are true and correct as therein stated. _________________________ _________________________ (Name & Signature of Mother) SWORN to and subscribed before me, this the ______ day of _________________, 20_____ (Date) . ____________________________ Notary Public My Commission Expires: ________________________ CERTIFICATE OF SERVICE We, ___________________________________________________ (Names of Father and Mother) , do hereby certify that a true and correct copy of the above and foregoing Joint Petition to Modify Divorce Decree by Terminating Child Support has been served, via US mail, postage prepaid, to the following: _____________________________ (Name of Appropriate Person at State Dept. of Human Services) _______________________________________ (Street Address or P O Box Number) _______________________________________ (City, State, Zip Code) This the ______ day of ________________, 20_____ (Date) . 3 Respectfully submitted, _________________________ (Name of Father) _________________________ (Name of Mother) 4