Fill and Sign the Petition for Modification Child Support Form

SU -W W W-M 001 ( 4 /9 8) THE STATE OF NEW HAMPSHIRE SUPERIOR COURT CountyCase No. In the matter of PETITION FOR MODIFICATION - CHILD SUPPORT 1.Your NameDate of BirthResidence AddressTown/CityCountyState2.Other Party’s NameDate of BirthResidence AddressTown/CityCountyState3.What t y p e o f c ase r e su lte d i n t h e p re se n t s u pport o rd er ( d iv orc e, p ate rn ity a ctio n, e tc .) ? A nd, w hat c o urt i s su ed t h e O rd er?4 .W hat i s t h e p re se n t s u pport o rd er ( d ate o f s u pport o rd er a n d a m oun t) ?5 .C hild re n f o r w hom s u pport i s p re se n tly o rd ere d :C H IL D N AM EDATE O F B IR THC H IL D N AM EDATE O F B IR TH6.R ea so n f o r R eq uest f o r M odif ic atio n ( c h eck o ne o r b oth ):I t h as b een 3 y ears s in ce t h e l a st c o urt o rd er c o ncern in g t h e a m ount o f s u pport.T here h as b een a s u bsta n tia l c h an ge o f c ir c u m sta n ces, a s f o llo w s ( b e s p ecif ic ):7 .P le ase c h eck o ne o f t h e f o llo w in g r e g ard in g p ublic a ssis ta n ce:N o p ublic a ssis ta n ce (A FD C/T A N F) is n ow b ein g o r h as w ith in th e la st 6 m onth s b een p ro vid ed , n or is me d ic al a ssis ta n ce ( M ed ic aid ) p re se n tly b ein g p ro vid ed , f o r a n y m in or c h ild l is te d i n P ara g ra p h 5 . SU -W W W-M 001 ( 4 /9 8)T he N .H . D ep artm en t o f H ealth a n d H um an S erv ic es is p ro vid in g o r h as p ro vid ed w ith in th e la st 6 m onth s pu b lic assis ta n ce (A FD C/T A NF) an d/o r m ed ic al assis ta n ce (M ed ic aid ) fo r an y m in or ch ild . If th is is ch eck ed , y ou m ust m ail c o pie s o f t h is p etitio n a n d t h e p ers o nal d ata s h eet t o t h e D ep artm en t a t: O CS L eg al O ffic e 6 H azen D riv e C onco rd , N H 0 3301 8 .B y f ilin g t h is p etitio n, y ou a re a sk in g t h at t h e c o urt: A . M od if y t h e p re se n t s u pport o rd er.B . G ra n t a n y o th er o rd ers w hic h m ay b e a p pro pria te ._ __ ____ _______ ______________ _____ _________________________________________D ate Sig natu re ( S ig n i n f ro nt o f N ota ry P ublic o r J u stic e o f t h e P eace) _ _________________________________________A tto rn ey ( if a n y)___________________________________________A tto rn ey ’s A ddre ss S ta te o f N ew H am psh ir e_ __ ____ _______ _________ C oun ty T he p ers o n s ig nin g th is p etitio n a p peare d a n d s ig ned it b efo re m e a n d to ok o ath th at th e s ta te m en ts in th is p etitio n a re tr u e, to th e b est o f h is o r h er k now le d ge a n d b elie f, a n d t h at h e/s h e h as m aile d c o pie s o f t h e p etitio n a n d p ers o nal d ata s h eet t o O CS ( if re q u ir e d u nder p ara g ra p h 7 ). ________________________________________D ate Nota ry P ublic /J u stic e o f t h e P eace