Fill and Sign the This Worksheet is to Assist You in Gathering Information Needed to

Modification of Child Support Information Worksheet This worksheet is to assist you in gathering information needed to complete the Complaint for Modification of Child Support, and is not filed with the court. It is not required and it is not a substitute for the complaint for modification. For the “Complaint for Modification of Child Support”: (Most of this information may be found on the most recent Child Support Order.) County where the most recent child support order was filed Full name of the plaintiff in the original action Full name of the defendant in the original action Date of the most recent order setting child support Who was ordered to pay child support? The month that the most recent child support order became effective ***Are you or the other party a member of the armed forces? The names and years of birth for each child covered under the most recent child support order Child's Name If support was ordered for more than one child, list the total amount of support per month and show how support will decrease as each child reaches the age of 19, dies, marries, or is emancipated. This calculation will be in the original support order. Support Amount If the support was ordered to stop temporarily or go down during certain describe what the order says about that. Page 1 of 3 Modification of Child Support Information Worksheet DC 6:14.3 Rev. 06/2019 Year of Birth # of Children Was the payor ordered to provide health insurance or cash medical support? Was the payor ordered to provide child care support? What is the change in circumstances since the last support order? Financial Affidavit for Child Support (additional information combined with above): If currently an order for support for minor children Name of the court Case number Amount of support Number of children Name of your employer Gross monthly income (before taxes) Hourly wage rate and # of hrs. (if hourly employee) OR Monthly wage (if salaried employee) Any regular bonuses received Name of other party employer Gross monthly income (before taxes) Hourly wage rate and # of hrs. (if hourly employee) OR Monthly wage (if salaried employee) Any regular bonuses received If your income has gone down: Name of past employer Gross monthly income (before taxes) Hourly wage rate and # of hrs. (if hourly employee) OR Monthly wage (if salaried employee) Any regular bonuses received If other party’s income has gone down: Name of past employer Gross monthly income (before taxes) Hourly wage rate and # of hrs. (if hourly employee) OR Monthly wage (if salaried employee) Any regular bonuses received Amount you pay for health insurance per month for children ONLY Page 2 of 3 Modification of Child Support Information Worksheet DC 6:14.3 Rev. 06/2019 Amount other party pays for health insurance per month for children ONLY Amount you contribute to retirement each month. Amount other party contributes to retirement each month. Other children you are paying support for (if any): For children NOT living with you: Names and years of birth Method of support Name of the court, if ordered Case number Amount For children who ARE living with you: Name of other parent, if not ordered Parent’s gross monthly income Other children other party is paying support for (if any) For children NOT living with the other party: Names and years of birth Method of support Name of the court, if ordered Case number Amount For children who ARE living with the other party: Name of other parent, if not ordered Parent’s gross monthly income Voluntary Appearance (additional information combined with above): The other party’s mailing address: Praecipe for Summons (additional information combined with above): The County and State where the other party will be served Page 3 of 3 Modification of Child Support Information Worksheet DC 6:14.3 Rev. 06/2019