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Petition for Modif ication of Child Support Revised October 2012 Page 1 of 6 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 ) PETITION FOR MODIFICATION OF CHILD SUPPORT AND JUDGMENT FOR ARREARS Petitioner respectfully requests this Court modify an order regarding child support, and, if applicable, enter a judgment for arrears /back child support . In support of this petition, the Petitioner states the following: 1. Petitioner is the custodial parent; OR non -custodial parent and is a resident of County, State of . 2. A child support order was entered by this Court on ; OR (date) entered by the Court, County, State of . 3. This Court made the original child support det ermination and has exclusive, continuing jurisdiction to modify the order and the child(ren) OR the Petitioner OR Respondent reside in this state. (If this court did not enter the original order or if n either party or the child(ren) continues to reside in this state, seek the advice of an attorney.) 4. The most recent child support order concerned the following minor child(ren): Child’s initials : Child’s year of birth : Present address: Petition for Modif ication of Child Support Revised October 2012 Page 2 of 6 Name( s) of person(s) with whom child( ren ) have lived with during the past 5 years Beginning Ending Date Date Present address of person(s) with whom child(ren) lived with during this period Attach a separate sheet if necessary Child’s initials : Child’s year of birth : Present address: Name( s) of person(s) with whom child( ren ) have lived with during the past 5 years Begin ning Ending Date Date Present address of person(s) with whom child(ren) lived with during this period Attach a separate sheet if necessary Child’s initials : Child’s year of birth : Present address: Name( s) of person(s) with whom child( ren ) have lived with during the past 5 years Beginning Ending Date Date Present ad dress of person(s) with whom child(ren) lived with during this period Attach a separate sheet if necessary 5. The Order or Decree establishing support : has not been modified or changed in this state or any other state with respect to the child support and medical insurance obligations; OR was last modified with respect to the child support and/or medical insurance obligations by order of this Court on ; OR (date) Petition for Modif ication of Child Support Revised October 2012 Page 3 of 6 was last modified with respect to the child support and/or medical insurance obligations by Order of the Court, County, State of , on . (date) 6. According to the terms of the most recent court order: Child support was not ordered; OR Child support was ordered as follows: The non -custodial parent is required to pay $ per month. The non -custodial parent is : In arrears (o wes back child suppor t). The amount of back child support owed is $ through the date of the filing of this Petition. Attach a copy of the payment record obtained from the Clerk of District Court or the Child Suppor t Enforcement Office. A judgment should be entered against the non -custodial parent for this amount and any additional amounts which may accrue prior to entry of an order in this action; OR Current in his/her supp ort obligation and does not owe any back child support; AND The custodial non -custodial parent is required to provide medical insurance for the child(ren). Such insurance has has not been provided as ordered; OR The non -custodial parent was required not required to pay for a percentage of medical expenses not covered by insurance. Such medical expenses have have not been paid as ordered. If the non -custodial parent has not paid medical expenses as ordered, the total amount owed is $ ______ through the date of the filing of this Petition (attach copies of bills/receipts, if available) . A judgment should be entered against the non -custodial parent for this amount and any additional amounts that are owed prior to entry of an order in this action ; OR Neither party has been ordered to provide medical insurance. Petitione r is requesting thi s Court order Petitioner OR Respondent to provide medical insurance and that all medical expenses not covered by insurance be divided in the following manner: % to be paid by Mother and ______ % to be paid by Fa ther . Petition for Modif ication of Child Support Revised October 2012 Page 4 of 6 7. Petitioner is seeking a modification of the child support order because: The child support order has not been entered or modified wit hin the six (6) months prior to the filing of this Petition. Applying the child support gu idelines established in Wyo. Stat. § 20 -2-304, the child support amount will change by twenty percent (20%) or more per month from the amount of child support required by the existing order; OR Since the date of the last order, there has been a substantial change of circumstances which warrants modifying the child support and/or medical insurance obligations. The change in circumstances is: Th ere are fewer children owed support because one of the children is emancipat ed or has reached the age of majority. (“Age of majority " means a person eighteen (18) years of age, however, for purposes of child support obligations, a parent's legal obligation for the support of his or her children, whether natural or adopted, continu es past the age of majority in cases where the children are: (i) mentally or physically disabled and thereby incapable of self support; or (ii) between the age of majority and twenty (20) years and attending high school or an equivalent program as full -time participants. ) The “net” income of one or both of the parents is believed to have substantially changed. ( "Net income" means income less personal income taxes, social security deductions, cost of dependent health care coverage for al l dependent children, actual payments being made under preexisting support orders for current support of other children, other court -ordered support obligations currently being paid and mandatory pension deductions. Payments towards child support arrearage shall not be deducted to arrive at net income .) The financial needs of the child(re n) have increased by reason of age and the cost of living changes. The obligations and rights of the parties and the child(ren) to pro vide or receive health care require review and modification. Other: [Please describe] ; OR It has been a t least three (3) years since a court reviewed the child support and, if appropriate, Petition er would like the court to adjust the order in accordance with the child support guidelines. Petition for Modif ication of Child Support Revised October 2012 Page 5 of 6 WHEREFORE, Petitioner respectfully requests: 1. The parties be ordered to complete and file Confidential Financial A ffidavits as provided by Wyo. Stat. § 20 -2-308; 2. The Court review and modify the child support order to an amount consistent with the Wyoming Child Support Guidelines ; 3. If applicable, t he Court review and modify the medical insurance obligation and the allocation of costs not covered by medical insurance ; 4. If applicable, the Court enter a judgment for child support arrears and for unpaid medical expenses n ot covered by medical insurance; 5. Other: 6. For such other and further relief as the Court deems necessary and just. DATED this day of , 20 . Signature Printed Name: Address: Phone Number: STATE OF ) ) ss. COUNTY OF ) Subscribed and sworn to before me by , this day of , 20 . Witness my hand and official seal. Nota rial Officer My commission expires: Petition for Modif ication of Child Support Revised October 2012 Page 6 of 6 -------------------------------------------------- Fill in, if applicable ---- ------------------------------ Pursuant to Rule 102(a)(1)(B) of the Wyoming Uniform R ules of District Court the following attorney has participated in the preparation of this pleading but said attorney is NOT deemed to have entered an appearance in this matter: _________________________________ Attorney’s Name Attorney’s Address/Telepho ne: __________________________________ __________________________________ __________________________________ __________________________________