Order Modifying Custody and Support
July 2014
Page 1 of 15
STATE OF WYOMING ) IN THE DISTRICT COURT
) ss
COUNTY OF ________________ ) _______________ JUDICIAL DISTRICT
Petitioner: ___________________________,) Civil Ac tion Case No. __________
(Print name of person filing) )
)
vs. )
)
Respon dent: _________________________ .)
(Print name of other party )
ORDER MODIFYING CUSTODY AND SUPPORT
THIS MATTER having come before the Court upon the Petition to Modify
Custody and Support ; and the Court, having reviewed the fi le herein, having heard the
arguments of the parties, if applicable, and otherwise being fully advised in the premises,
FINDS:
1. This Court has jurisdiction over the parties and the subject matter of these
proceedings.
2. The Respondent was served with the Peti tion to Modify Custody and Support :
[check one]
Personally (by the sheriff) on the following date______________ in the
following state: _______________ ; OR
Respondent accepted service ( Acknowledgement and Acceptance of S ervic e
must be filed. Respondent’s signature must be notarized.); OR
By publication. ( Copy of Affidavit of Publication must be filed.); OR
By Registered or Certified Mail . (R eturn receipt must be filed and Clerk must
have entered certificate of service .)
3. Respondent filed [check one]
a Response ; OR
a Response and Counterclaim ; OR
no response (default must be entered , unless there is a waiver of right to
answ er); OR
no response but both parties have signed and agreed to the entry of this
Order.
Order Modifying Custody and Support
July 2014
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4. An Order establishing custody and support was entered by the
Court, District, State of ___________________,
case/docket number ___ _____________ on [date] .
5. In the Order, Mother Father was granted custody of the parties’ minor
child[ren] and Mother Father was ordered to pay $____________ per month in
child support and Mother OR Father OR Both Parents was/were ordered to
provide medical insurance coverage.
6. A material change in circumstances exist s and it is in the best interest of the
child (ren ) to mod ify custody.
7. The parties are the natural or adoptive parents of the following minor child(ren) :
Child’s Initials : Year of Birth :
Child’s Initials : Year of Birth :
Child’s Initials : Year of Birth :
Child’s Initials : Year of Birth :
Additional sheets of paper are attached if needed
8. Custody of the child(ren) should be as follows:
The parties have joint legal custody and Mother or Father has physical
custody; OR
The parties have joint legal and joint physical custody; OR
Mother or Father has sole legal and physical custody; OR
Other (Please describe desired legal and physical custody a rrangement in
detail) __________________________________________________________________
________________________________________ ________________________________
________________________________________________________________________
9. The parties have an obligation to contribute to the support and maintenance of the
parties’ minor child(ren).
Unless defined another way in this Order , “Joint Legal Custody” means that both part ies have access to
the records of the child(ren) including school records, activities, teachers and teachers' conferences, as
well as medical and dental treatment providers and mental health records. Both parties have these
rights unless the Court limits that access.
Order Modifying Custody and Support
July 2014
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IT IS HEREBY ORDERED THAT:
10 . CHILD CUSTODY, VISITATION AND SUPPORT:
A. CUSTODY :
The parties shall have joint legal custody and Mother or Father
shall have physical custody; OR
The parties shall have joint legal and physical custody. The parties shall
share physical custody of the minor children as described on the attached sheet of
paper.
Attach a schedule describing the sharing of physical custody.
Skip to Section C – Child Support; OR
Mother OR Father shall have sole legal and physical custody. List
the rea sons why joint legal custody is not appropriate:
OR
Other (Please describe desired legal and physical custody arrangement
in detail): ___________________________________________________
_______________________ ____________________________________ _
___________________________________________________________ _
____________________________________________________________
B. VISITATION :
The child(ren) shall spend time with the non -custodial parent as the parties may
agree, but if they cannot agree, then time shall be spent with the child(ren) as follows:
B.1. WEEKENDS : The child(ren) shall spend time with Mother OR
Father every weekend eve ry weekend when Friday is an even date
every weekend when Friday is an odd date other (specific weekends such as
1st and 3rd):
from a.m./p.m. to a.m./p.m.
B.2. OTHER VISITATION : In addition to the Weekend visitation above, the
child(ren) shall also spend time with Mother OR Father as follows (specify
specific days and times such as each Wednesday from 4:00 p.m. to 8:00 p.m.,
etc.):
Additional sh eets of paper are attached (if necessary).
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July 2014
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B.3. SUMMER SCHEDULE : (Choose one)
Option 1: Mother OR Father shall have visitation with the parties’
child(ren) beginning and continuing
until (i.e. ten days
after school lets out from 5:00 p.m. and continuing until ten day s prior to school
starting up again at 5:00 p.m.).
The other parent shall have the same Weekend and Other Visitation as described
in paragraphs B.1 and B.2 above during the summer; OR
Option 2: The summer schedule will remain the same as during the school
year ; OR
Option 3: The summer schedule will be as follows:
Additional sh eets of paper are attached (if necessary).
B.4. HOLIDAY SCHEDULE : The following holi day schedule will take priority
over the regular weekday, weekend, and summer schedules described above. Fi ll
in the blanks below with Mother or Father to indicate who the child(ren) will be
with for the holidays. Provide beginning and ending times. If a h oliday is not
specified as even, odd, or every year with one parent, then the child(ren) will
remain with the parent they are normally scheduled to be with.
Location of exchange and transportation arrangements for the following holidays or events shall fo llow the
instructions set forth in paragraph 10 .B.11. unless stated otherwise.
(Be very specific about the days, times, and location where exchanges will take place)
Holiday/Event Odd
numbered
years
Even
numbered
years
Every
year Day, Time and Place of E xchange
Describe from start to end ( for example, Friday
when school lets out until Monday at 6 p.m.)
(Mother or Father)
Mother’s
Day Weekend
Memorial
Day Weekend
Father’s Day
Weekend
July 4 th
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July 2014
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Labor Day
Weekend
Thanksgiving
Break
First part
Thanksgiving
Break
Second part
Winter
Break
First part
Winter
Break
Second part
Spring
Break
First part
Spring
Break
Second part
Child(ren)’s
Birthdays
Religious/Other Events
(Specify):
(Specify):
(Specify):
Additional sh eets of paper are attached (if necessary).
B.5. OTHER (including no visitation or supervised visitation) : If you
require a schedule that is difficult to explain in the for mat above or if your
situation is unique such that visitation is not appropriate or requires supervision,
please provide a detailed visitation schedule that fits your needs or an explanation
of why visitation is not appropriate on a separate sheet of paper and attach it.
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July 2014
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B.6. TEMPORARY CHANGES TO THE SCHEDULE : Any schedule for
sharing time with the child(ren) may be changed as long as both parents agree to
the changes ahe ad of time, in writing.
B.7. PERMANENT CHANGES TO THE SCHEDULE : Once the judge sig ns
the final Order Modifying Custody & Support in your case and approves this
Visitation Plan, any changes that the parents do not agree on can be made only by
applying to the court for a modification. One parent cannot change a court -
ordered Visitation Pl an on their own.
B.8. PARENT -CHILD COMMUNICATION : Both parents and child(ren)
shall have the right to communicate by telephone, in writing or by electronic
means during reasonable hours without interference or monitoring by the other
parent , unless oth erwise ord ered by the C ourt.
B.9. MUTUAL RESPECT : Parents will not say things or knowingly allow
others to say things in the presence of their child(ren) that would take away the
child(ren)’s love and respect for the other parent.
B.10 . OTHER TERMS :
A. The party who has custody of the children or the party who is
exercising visitation with the children shall:
i. Care for, control, protect, and reasonably discipline the
child( ren );
ii. Provide the child(ren) with adequate food, clothing, and
shelter, and medical and dental care ;
iii. Promote and encourage the training and education of the
child(ren);
iv. Respect the other party’s rights and responsibilities regarding
the other party’s time with and care of the child(ren).
B. Visitation MAY NOT be reduced or denied because su pport is not
paid.
C. Add any other items regarding the child(ren) you would like to include
concerning visitation .
______________________________________________________
Additional sh eets of paper are attached ( if necessary).
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July 2014
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B.11 . EXCHANGE OF CHILD(REN)/COST OF TRANSPORTATION :
Both parents shall have the child(ren) ready on time and at the agreed -upon time
of exchange. All clothing that accompanied the child(ren) shall be returned to the
other parent at the end of that particular visitation. All transportation in
connection with the visiting parent’s exercise of his/her visitation shall be the
responsibility of and/or paid for as follows:
Option 1: While both parents continue to reside within ____ miles of
each other , both parents shall be responsible for transportation costs for one -way
of the children’s transportation. Mother Father shall pick up the child(r en)
from at the beginning of the visi tation and
(location)
Mother Father shall pick up the child(ren) at the end of the visitation from
_____________________________________________________ . If either party
(location)
moves miles or more away, then the costs for transportation shall be
as follows:
; OR
Option 2 : The visiting parent shall be responsible for all of the child(ren)’s
transportation costs. Mother Father shall pick up the child(r en)
from_________________________________ at the beginning of the visitation
(location)
and shall return the children to_________________________________ at the end
(location)
of the visitation ; OR
Option 3 : Other: (provide details exchange and transportation costs ):
ONCE FILED, T HE PARTIES MAY MAKE SUBSTANTIAL, PERMANE NT
MODIFICATIONS TO THI S VISITATION PLAN ONLY BY WRITTEN AGREEMENT
SIGNED BY BOTH PARTI ES, APPROVED BY THE JUDGE AND FILED WITH THE
COURT. MINOR, NON -PERMANENT CHANGES MA Y BE MADE ANY TIME I F BOTH
PARTIES AGREE TO T HE CHANGES.
C. CHILD SUPPORT:
The child support amount may depend on the custodial arrangement that is ordered by the court. If each parent
keeps the children overnight for more than forty percent (40%) of the year and both parents contribute
substantially to the exp enses of the children in addition to the payment of child support, a “joint presumptive
support” obligation shall be determined by use of the tables. Also, when each parent has physical custody of at
least one (1) of the children, a “shared presumptive su pport” obligation for all of the children shall be
determined by use of the tables. See Wyo. Stat. §20 -2-304(c) and (d). For assistance in calculating child
support, go to the following website :
http://www.laramiecounty.com/_departments/_district_court/calculator.aspx or call your local child support
enforcement agency.
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July 2014
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In accordance with W yo . Stat . § 20 -2-304, presumptive child support is calculated as
follows :
1. Number of children:
2. Father’s net monthly income is: $_______
3. Mother’s net monthly income is: $_______
4. Total child support obligation of both parents is: $_______
5. Father’s presumptive child support obligation is: $_______
6. Mother’s presumptive child support obligation is: $_______
C.1. Restriction on reducing amount of child support: No agreement which is
less than the presumed child support amount in the law shall be approved if public
support/benefits such as aid under the personal opportunities with employment
responsibilities (POWER) program, Title 19, Kid Care, food stamps,
supplemental security inc ome (SSI) or other similar benefits are being paid on
behalf of any of the children. CHECK ONE :
The child(ren) receive(s) public assistance; OR
The child(ren) DO NOT receive(s) any public assistance .
C.2. Amount o f Child Support : Mother OR Father shall pay $_________
per month for child support. The amount of child support is based upon:
The presumptive amount of child support determined by Wyoming’s
Child Sup port Guidelines; OR
There is a deviation (an adjustment) upwards or downwards from
the presumptive amount. (In order to deviate, there must be a specific finding
that the application of the presumpt ive child support would be unjust or
inappropriate). The reasons that the presumptive amount is unjust is because
(list the specific reasons):
C.3. Time of Payments : Child support payments shall begin:
on THE FIRST DAY OF THE MONTH beginning the month of
, 20 and shall continue to be paid on the first day of
the month thereafter, until further order of the court; OR
beginning on the ____ day of _____________, 20______ and continuing
as follows: .
C.4. CONTINUATION OF CHILD SUPPORT: Child support shall continue
during the minor child’s minority, and beyond if the child has a mental, emotional
or physical impairment preventing emancipation, or while the child is atte nding
high school or an equivalent program as a full -time student between the ages of
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July 2014
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18 and 20. Child support shall terminate if, during the child’s minority, the child
marries, is emancipated, becomes self -supporting or dies.
C.5. PLACE:
All payments required under this Order, shall be made to one of the two following
addresses:
Clerk of the District Court, whose address is
(see District Court Clerks Addresses in this
packet):
_______________________________
_______________________________
________ _______________________
OR State Disbursement Unit
2300 Capitol Ave.
Hathaway Bldg., 5th Floor, Suite A
Cheyenne, WY 82002
DO NOT PAY BY PERSONAL CHECK. CASH ACCEPTED IN PERSON
ONLY. CASHIER’S CHECKS AND MONEY ORDERS ACCEPTED.
The Clerk or SDU shall pro mptly forward the support payments to the receiving
parent at the address provided by that parent . Each party shall pay, when due,
all fees charged to that party by the Clerk of District Court, State
Disbursement Unit, and any other agency statutorily auth orized to charge a
fee.
C.6. MODIFICATION: Either party may seek a modification of the child
support ordered herein pursuant to Wyo. Stat. §20 -2-311.
MO DIFICATION OF CHILD SUPPORT NOT EFFECTIVE UNLESS IT
IS APPROVED BY A WRITTEN ORDER SIGNED BY THE JU DGE.
C.7. ABATEMENT OF CHILD SUPPORT (Temporary Relief from
Paying): Wyo. Stat. §20 -2-305 says child support may abate or decrease by one -
half (1/2) of the daily support obligation for each day the noncustodial parent has
physical custody of the child for whom support is due, ONLY IF the noncustodial
parent has custody of the child for more than fifteen (15) consecutive days and if
approved by the Court.
REQUIREMENTS:
A. The non -custodial parent MUST FILE any claim for child support
abatement wit h the clerk of the court within thirty (30) days after
the period for which abatement is claimed and must pay ten dollars
($10.00) to the clerk when filed.
B. The clerk will then mail a copy of the claim to the custodial parent.
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July 2014
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C. The custodial parent can object or dispute any abatement claim by
filing an objection with the clerk of court within thirty (30) days of
the date the clerk mailed the notice to the custodial parent and
paying ten dollars ($10.00) to the clerk.
D. The clerk will mail a copy o f the objection to the noncustodial
parent.
E. Claims or objections not filed in a timely manner or not
accompanied by the ten dollar fee will be rejected.
C.8. ENFORCEMENT: Either party has the right to petition to enforce an order
pursuant to Wyo. St at. §20 -2-201 through §20 -2-204 and §20 -2-311(d).
Wyoming law states that any payment of child support not paid when due shall
automatically become a judgment against the parent who is supposed to pay on
the due date. This judgment is subject to a 10% la te payment penalty if it is not
paid within thirty -two (32) days.
11. MEDICAL INSURANCE :
The Mother OR Father OR Both shall provide health care insurance
coverage for the minor child(ren) if insurance can be obtained at a reasonable cost and
the benefits under the insurance policy are accessible to the child(ren).
11 .A. Proof. The insuring parent shall provide to the Court written proof that
the insurance has been obtained within sixty (60) days aft er it became
available . Proof of insurance coverage shall contain, at a minimum:
i) The name of the insurer .
ii) The policy number .
iii) The address to which all claims should be mailed .
iv) A description of any restrictions on usage, such as pre -approva l for
hospital admission, and the manner in which to obtain pre -
approval .
v) A description of all deductibles .
vi) Two (2) copies of claim forms.
11 .B. Changes. The insuring parent shall provide written notice to the Clerk of
this Court and the other par ent if insurance coverage for the child is
denied, revoked, or altered in any way that would affect the child's
coverage, including any change relating to the information required above.
11 .C. Failure To Provide Insurance . The Court may hold an obligated parent in
contempt for refusing to provide the ordered insurance or for failing or
refusing to provide the information required above. In addition, if either
parent fails to provide insurance or proof of insurance as required by this
agreement, the other parent may provide such insurance and the obligated
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July 2014
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parent shall be liable to the other parent for the cost of such insurance plus
the costs incurred in collection, including reasonable attorney’s fees.
11 .D. Costs Not Paid For By Insurance . The parents are jointly liable to
providers for all health care expenses (including, but not limited to,
medical, dental, orthodontic, optical, prescription drugs, counseling, and
all other health care expenses) of the child(ren). All deductibles, co -
payments and oth er expenses for health care that is not paid for by health
insurance shall be paid by the parents as follows:
50% each by Mother and Father; OR
% by Mother and % by Father.
i) If the insuring parent fails to pay th e insurance premium, all health
care expenses of the children not covered by insurance shall be the
responsibility of that party.
ii) If the insuring parent fails to maintain insurance as required, that
party may be found in contempt of Court and may be required to
pay or reimburse the expenses and costs set forth in Wyo. Stat.
§20 -2-401(e).
12. CHANGES IN ADDRESS AND EMPLOYMENT:
Each parent shall inform the other parent and the clerk of court in writing of any
change of address, phone number, and emplo yment:
12.A. CHANGE OF EMPLOYMENT STATUS : S o long as there is a child
support obligation, each parent shall notify the other parent and the Clerk of this
Court, in writing, on forms available from the Court, within fifteen (15) days of
any change in empl oyment, including second jobs, changed employers, starting or
ending unemployment compensation, and starting or ending of worker’s
compensation, or any other change in income.
12.B. CHANGE OF ADDRESS : So long as there is a child support obligation,
if ei ther parent plans to change his or her address, that parent must n otify the other
parent and the Clerk of this C ourt, in writing, on forms available from the Clerk
of this Court, no later than fifteen (15) days prior to the day of the move, the
destination of the move and the proposed move date.
12.C. CHANGE OF HOME CITY OR STATE OF RESIDENCE: Either
parent who plans to change their home city or state of residence, must give
written notice thirty (30) days prior to the move , both to the other parent and to
the clerk of district court stating the date and destination of the move.
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July 2014
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13. INCOME WITHHOLDING ORDER :
An income withholding order shall be entered and shall become effective as
follows:
Effective immediately ( Recommended ); OR
Effective upon the date the Obligor requests withholding commence; or the
date the Obligor becomes delinquent in payment of an amount equal to one (1) month’s
support obligation under the support order. List the reasons why good cause ex ists to
delay the effective date for withholding income:
; OR
OTHER (i.e. Mili tary allotment) .
14. PREVIOUS SUPPORT ORDER :
According to the terms of the most recent court order, Petitioner OR
Respondent was ordered to pay $ per month for the support of the
minor child (ren ).
15. JUDGMENT OF ARREARS :
15.A. Petitioner OR Respondent is in arrears in the support obligation in
the amount of $ from ___ [Date of previous
support order ] through [Last day of the month before this
Order is filed] for which judgment shall be entered; AND/OR
Petitioner OR Respondent owes unpaid medical expenses in the amoun t of
$ from __ [Date of the order establishing medical
support] through [Last day of the month before this Order is
filed] , for which judgment shall be entered; OR
15.B. Petitioner OR Respondent is current in h is/her support obligation.
IT IS HEREBY ORDERED THAT :
16. Judgment for past due support, including medical support if applicable, is hereby
entered against Petitioner OR Respondent in the amount of $
through [Date] . Beginning [Date] ,
Petitioner OR Respondent shall pay $ per month in addition
to current support towards the judgment of $ [total amount o f judgment
listed in paragraph 15.A. ] until the judgmen t is pai d and satisfied in full; OR
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July 2014
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Petitioner OR Respondent is current in his/her support obligation and a
judgment for past due support or medical support is not needed.
17 . TAX EXEMPTION :
The parties shall claim as income tax dependency exemptions on federal and state
tax returns as follows :
Initials of C hild (ren) Parent Entitled to Claim Year Allowed to Claim
M other Father every odd even
Other: ______
M other Father every odd even
Other: ______
M other Father every odd even
Other: ______
M other Father every odd even
Other: ______
provided that the party required to pay child support is only entitled to claim the
exemption(s) if he/she is current on his/her child support obligation as of December 31 st
of the year in which the exemption(s) is claimed. The parties shall sign all necessary t ax
forms to allow the other party to claim the exemption(s) as stated above.
18 . Any provision in the previous order not otherwise modified herein shall remain in
full force and effect.
19 . ENFORCEMENT OF ORDER:
Either party or, whe n appropriate, the department of family services has the right
to petition to enforce an order pursuant to W yo . Stat . §20 -2-201 through 20 -2-204,
20 -2-310 and 20 -2-311(d).
Contempt - Pursuant to Wyo. Stat. §20 -2-204 and 20 -2-310, a court
having jurisdict ion to enforce or revise the decree or order may, upon
appropriate motion of either parent, require a parent to appear
before the court and show just cause why the parent should not be
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July 2014
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held in contempt, upon a showing that the parent has willfully
violated the decree or order as to the care, custody, visitation and
maintenance of the children. The court may, in addition to any
assessment it may impose upon a finding that the parent is in
contempt of court, award attorney's fees, costs, and such other and
further relief as the court may deem necessary under the
circumstances, to the parent aggrieved by the violation of the decree
or order , in order to enforce and require future compliance with the
decree or order .
20. LIMITED REPRESENTATION :
Following Rule 1.2(c) of the Wyoming Rules of Professional Conduct, any
attorney who has entered a limited appearance for the purpose of obtaining an Order
Modifying Custody and Support is now discharged.
SO ORDERED this day of , 20 .
DIS TRICT COURT JUDGE
CHECK ONLY ONE BOX, AND SIGN WHERE INDICATED IN THAT
SECTION ONLY :
If the parties have agreed:
I certify that I have read the foregoing Order Modifying Custody and Support and
that I agree to the terms and agree to entry of the Order .
_______________________________ ____
Petitioner’s signature
STATE OF ______________________ )
) ss
COUNTY OF ____________________ )
Subscribed and sworn to before me by _________________________________,
this ______ day of ____ _________________, 20 ______.
Witness my hand and official seal
______________________________
Notarial Officer
My Commission Expires:
Order Modifying Custody and Support
July 2014
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______________________________ ______
Respondent’s signature
STATE OF ______________________ )
) ss
COUNTY O F ____________________ )
Subscribed and sworn to before me by _________________________________,
this ______ day of _____________________, 20 ______.
Witness my hand and official seal
______________________________
Notarial Officer
My Commission Expire s:
If default has been entered and the Respondent did not respond:
The above is true and accurate and I want the court to approve:
______________________________
Petitioner’s signature
If a cou rt hearing was held :
APPROVED AS TO FORM:
_______________________________ ______________________________
Petitioner’s signature Respondent ’s signature
Copies sent to:
Petitioner /Petitioner’s Attorney’s Name and Address
Resp ondent /Respondent’s Attorney’s Name and Address