251 Superior Court of Arizona in Maricopa County DRMW11f-010119 ALL RIGHTS RESERVED Page 1 of 2 Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: ATLAS Number: Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY (2) (3) Case No. Petitioner (in original case) (4) ATLAS No. (2) Respondent (in original case) I, (5) , ask the court to modify the Income Withholding Order (Order requiring an employer or other payor to withhold funds for child support or spousal maintenance) in which: (a) i s the person ordered to make payments, and (b) i s the person entitled to receive payments. Issued this date: (6) (Month/Day/Year) Issued by this Court: (Name of Court) Located in this County: (Name of County) Located in this State: (Name of State) because: (Check the appropriate box(es)) (7) The amount shown on the Income Withholding Order is wrong because: (7a) The amount was changed by Court Order issued on this date: (Month/Day/Year) in this county: , OR PETITION TO MODIFY INCOME WITHHOLDING ORDER A.R.S. 247 25 - 504 An Income Withholding Order is a court order that requires an employer to withhold money from the funds of a person ordered to pay child support and/or spousal maintenance (alimony). THIS FORM WILL NOT AFFECT THE AMOUNT OF SUPPORT ORDERED TO BE PAID; IT ONLY AFFECTS THE AMOUNT OF SUPPORT DEDUCTED FROM FUNDS . American LegalNet, Inc. www.FormsWorkFlow.com Case No. 251 Superior Court of Arizona in Maricopa County Page 2 of 2 DRMW11f-010119 ALL RIGHTS RESERVED (7b) The person making payments no longer owes (Check all that apply) Current Child Support Child Support arrearages (back child support) and interest Current Spousal Support Spousal Support arrearages (back alimony) and interest Reason(s) why money is no longer owed for any items checked in item ( 7b) : (List and attach any supporting documents.) (8) For the reasons listed in above , the amount ordered assigned should be changed from the current Amount of (8a) $ to the new amount of (8b) $ (9) The current Income Withholding Order should be modified because the presumptive termination date (the day the order will end) is wrong. The termination date should be changed from the date listed on the current Income Withholding Order: (9a) (Month/Day/Year) To the new date of (9b) (Month/Day/Year) Explain why the presumptive termination date is wrong (list and attach any supporting documents). (10) OATH OR AFFIRMATION AND VERIFICATION I swear or affirm that the information on this document is true and correct under penalty of perjury. Signature Date STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: by (Date) . (notary seal) Deputy Clerk or Notary Public NOTICE TO THE PARTY SERVED WITH THIS PETITION: If you do not agree with this Petition, you have twenty (20) days, or thirty (30) days if service is made outside the state of Arizona, in which to respond by completing a petition for hearing. If requested, a hearing will be set. The forms necessary t o request a hearing are available from the Clerk of Superior Court, for purchase from the Law Library Resource Center , or they may be downloaded for free from the internet . If you do not request a hearing in writing within the time allowed, the Court will review the Petition to Modify ( Change) Income Withholding Order and grant the request, if appropriate. American LegalNet, Inc. www.FormsWorkFlow.com