(1) Person Filing: Mailing Address: City, State, Zip Code: Daytime Phone: Evening Phone: Representing: [ ] Self or [ ] Attorney State Bar Number (if applicable) ARIZONA SUPERIOR COURT, COUNTY OF (2) (5) Case No. (3) Petitioner/Plaintiff ATLAS No. DOB SSN REQUEST TO MODIFY CHILD SUPPORT PURSUANT TO GUIDELINES SIMPLIFIED PROCEDURE (4) Respondent/Defendant DOB SSN IMPORTANT NOTICE TO PARTY NOT REQUESTING THE MODIFICATION Your support order may be modified , if you do not request a hearing (6)I, , [ ] Obligor [ ] Obligee, ask this court to by modify the Arizona child support order in this case entered on (7) (8) . 1. The child support order currently in effect requires (9) to make payments of (10) $ per , payable on the of the month. day(s) 2. Attached is a Parent's Worksheet for Child Support Amount. According to the worksheet calculations, the child support amount should be (11) $ per month. 3. The following calculations show that the requested change varies from the current ordered amount by 15% or more. (12)(a) ÷ (b) = (c) % a = the difference between the amount currently ordered and the amount requested 02/01/00 reqtomod.wpd 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com b = the amount currently ordered; and c = the percentage change 4. Is Department of Economic Security (DES) providing child support enforcement services for at least one of the parties? (13) [ ] Yes [ ] No [ ] Unknown If YES, see instructions, "When You Have Completed This Form." 5. Other court-ordered payments included in the current Order of Assignment (14) Spousal Maintenance Payments on Arrears : Child Support Spousal Support Other $ $ $ $ per per per per WHEREFORE, I request that child support be ordered in the amount of (15) $ month and that relief requested in the Parent's Worksheet be ordered. per If this matter goes to hearing, I further request that costs and fees incurred in bringing this action be ordered to be paid by the opposing party. I have read this document and the information given here is true and correct to the best of my knowledge. Date State of Arizona County of (16) Requesting Party’s Signature ) )ss. Acknowledged before me on: ) My Commission Expires: Notary Public or Clerk 02/01/00 reqtomod.wpd 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com NOTICE TO PARTIES If you do not agree with the modification to your child support, you have 20 days in which to ask for a hearing on the requested modification. If service of process is made outside the State of Arizona, the parent receiving service has 30 days in which to ask for a hearing on the requested modification. Upon proof of service and if no hearing is requested within the time allowed, the court will review the request and enter an appropriate order modifying the support award. If an error is noted, the amount awarded may be different from the amount requested, but there will be no greater modification than requested. In the event the court has serious concerns regarding the accuracy of the information, or if a substantial mathematical error is found, the court may set the matter for hearing. If either party requests a hearing within the time allowed, the court shall conduct the hearing. No order shall be modified without a hearing if a hearing is requested. If you wish to request a hearing, you may obtain the following forms from the Office of the Clerk of Superior Court. Request for Hearing and Notice of Hearing Parent's Worksheet for Child Support Amount 02/01/00 reqtomod.wpd 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com