Fill and Sign the Temporary Stipulated Agreement to Modify Support Obligation Form

IN THE CHANCERY COURT OF __________________ COUNTY, MISSISSIPPI _______________ JUDICIAL DISTRICT DEPARTMENT OF HUMAN SERVICES STATE OF MISSISSIPPI PLAINTIFF VS. CIVIL ACTION NO. ___________________________________________ (Name of Defendant) DEFENDANT TEMPORARY STIPULATED AGREEMENT TO MODIFY SUPPORT OBLIGATION STATE OF MISSISSIPPI COUNTY OF _________________ On this the ______day of ______________, 20_____, I, _________________________ (Name of Defendant) , appearing before the undersigned authority and after having been first duly sworn, state under oath as follows; 1. I am a resident of _________________ County, with a mailing address of _________________ (city), and acknowledge that I have a legal obligation to support the following named child: Name __________________________________Birth Date _______________________________________2. An order establishing my child support obligation of ___________ (amount) was entered by this Court on ________________ (date). I am currently on active duty with the U.S. Army and based on the increase in my monthly income, my monthly support obligation should be temporarily increased to $____________ beginning _________________________ (date).3. I understand this upward modification is temporary and will only be valid for a time period of one year from the beginning date indicated in the paragraph above, or until I am released from active duty, whichever time period is less. Within five (5) days of my release from active duty, I am to report my release to the Department of Human Services so the Department may take the necessary actions to return my obligation to the prior amount of $_____________. 4. My requirements not addressed in this agreement shall remain as previously ordered, including, but not limited to, any arrears obligations. 5.I agree to pay said sum through the Mississippi Department of Human Services in care of the Central Receipting and Disbursement Unit, P 0. Box 4301, Jackson, MS 39296. 6. I also understand and agree that the Department of Human Services has the right to enter a separate Order for Withholding to collect the above sums. 7. I also understand and agree that I have an obligation to inform the Department as soon as practical after being relieved of active duty. 8. I understand that this Agreement, once approved by the Court, will have the same force and effect and be enforceable as any other order entered in such cases. 9. I agree to abide by all the terms of this Agreement and further state that I will not interfere with the enforcement thereof. ____________________________________ (Name of Defendant) STATE OF ___________________COUNTY OF ____________________ Personally appeared before me, the undersigned authority in and for the aforesaid jurisdiction, the within-named __________________________ (Name of Defendant), who, after having been first duly sworn, stated on oath that the matters and facts set forth in the above and foregoing Affidavit are true and correct as therein stated.SWORN to and subscribed before me, this the day of _____________, 20____._________________________________ Notary Public or Commissioned Officer in the United States Army My Commission Expires: ____________________