Person Filing: Mailing Address: City, State, Zip Code: Daytime / Evening Phone: In this case I am: Attorney for : (IF)Attorney, Name: (1) FOR CLERK’S USE ONLY Petitioner or Petitioner or Respondent Petitioner Bar No. SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY (2) Petitioner (in original case) (3) Case No. (4) ATLAS No. (2) Respondent (in original case) PETITION TO MODIFY ORDER OF ASSIGNMENT A.R.S. § 25-504 An Order of Assignment 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. I, (5) , ask the court to modify the Order of Assignment (Order requiring an employer or other payor to withhold funds for child support or spousal maintenance) in which: (a) Is the person ordered to make payments, and Is the person entitled to receive payments. (b) Issued this date: (6) Issued by this Court: Located in this County: Located in this State: (Month/Day/Year) (Name of Court) (Name of County) (Name of State) because: (Check the appropriate box(s)) (7) The amount shown on the Order of Assignment is wrong because: (7a) The amount was changed by Court Order issued on this date: (Month/Day/Year) in this county: (7b) The person making payments no longer owes (Check all that apply) , OR Current Child Support. Child Support arrearages (back child support) and interest Current Spousal Support Spousal Support arrearages (back alimony) and interest © Superior Court of Arizona in Maricopa County November 26, 2007 ALL RIGHTS RESERVED DRMW11f Page 1 of 2 Use most current version of form American LegalNet, Inc. www.FormsWorkflow.com Case No. ________________________ 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 Order of Assignment 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 Order of Assignment: (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) OATH OR AFFIRMATION I swear or affirm that the information on this document is true and correct under penalty of perjury. (10) Signature Date Printed Name 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 the attached petition for hearing. If requested, a hearing will be set. If you do not request a hearing in writing within the time allowed, the Court will review the Petition to Modify (Change) Order of Assignment and grant the request, if appropriate. © Superior Court of Arizona in Maricopa County November 26, 2007 ALL RIGHTS RESERVED Page 2 of 2 DRMW11f Use most current version American LegalNet, Inc. www.FormsWorkflow.com