Fill and Sign the State of Indiana in Thecourtcounty Form

1 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) VS. CASE NUMBER _________ ________________________________ (Name of Parent Paying Child Support) Joint Petition to Modify Divorce Decree by Terminating Child Support 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 daughter __________________ (Name of Daughter), (hereafter referred to as Daughter ) and in support of this Petition would show unto this Honorable Court the following matters and facts, to-wit: 1. _____________________ (Name of Daughter), the minor child of the former marriage of Petitioners, will turn _____ (age) in December of this year; her date of birth being 12/15/90. Daughter is not going to school and no longer lives at home in __________________________ ( Name of County and State ), with her mother nor does she live with her father. She recently moved to ______________________ ( Name of City and State ) Hattiesburg and lives on her on. 2. Petitioners ___________________ (Name of Mother), and ______________________ (Name of Father) are concerned that if __________________ (Name of Daughter)’s, which amounts to $__________per month, is not terminated, she will continue to do nothing as far as getting a job or going to school. 2 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 Daughter, and/or be responsible for or required to pay Daughter’s dental, hospital and/or prescription drugs. And if Petitioners have prayed for wrong and improper relief, then they prays 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: ________________________ 3 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). Respectfully submitted, 4 _________________________ (Name of Father) _________________________ (Name of Mother)