JDF 1403 R 2 - 1 8 VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO 24714 - 10 - 122, C.R.S. Page 1 of 3 District Court Denver Juvenile Court County, Colorado Court Address: In re: The Marriage of: The Civil Union of: Parental Responsibilities concerning: Petit ioner: and Co - Petitioner/Respondent: COURT USE ONLY Attorney or Party Without Attorney (Name and Address) : Phone Number: E - mail: FAX Number: Atty. Reg.#: Case Number: Division Courtroom MOTION TO MODIFY CHILD SUPPORT PURSUANT TO 24714 - 10 - 122, C.R.S. Note to Responding Party: If you disagree with this M otion, the Colorado Rules of Civil Procedure allow you to file a written response with the Court which must be filed within 2 1 days of the date this M otion was served on you or mailed to you. The Petitioner Co - Petitioner/Respondent states the following for the purpose of modifying child support. 1. Information about Petitioner: Date of Birth: Cur rent Mailing Address: City & Zip: Home Phone #: Work Phone #: Cell # : 2. Information about Co - Petitioner/Respondent: Date of Birth: Current mailing address: City & Zip: Home Phone #: Work Phone #: Cell #: 3. Th e parties have minor child ( ren ) : Full Name of Child Present Address Sex Date of Birth 4. Un der the current Support Order, the Petitioner has overnights per year with the children and the Co - Petitioner/Respondent has overnights per year with the children. American LegalNet, Inc. www.FormsWorkFlow.com JDF 1403 R 2 - 1 8 VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO 24714 - 10 - 122, C.R.S. Page 2 of 3 5. Under the current child support order, the Co - obligation is $ and is paid week ly bi - weekly twice a month mont hly Other: . 6. (Check only if applicable.) The current support order does not contain a provision regarding medica l insurance (medi c al, dental, and/or vision) coverage . 7. A change in the current Support Order is appropriate because of the following change ( s ) in circumstance(s). Please check the appropriate box . Day Care costs Change in Income Change in Paren ting Time Change in Residence Emancipation of a C hild Medical insurance coverage Other: Describe why you are requesting the modification. 8. The new child support obligation that I am requesting is is not more than a 10% change from the current child support order. The proposed child support obligation should be $ to be paid weekly bi - weekly twice a month mont hly other : . 9. I/We have completed a child support worksheet that shows what the new child support obligation should be. The child support worksheet is is not attached to this Motion. 10. I/We have attached current Sworn F inancial Statement s to this Motion. 11. Is either party currently receiving public assistance? Yes No If you checked Yes , answer the following: Name of Person Receiving Benefit Name of County or State 12. Is ei ther party receiving child support enforcement services. Yes No If Yes , identify (County) (State). 13. Does either parent live in another state? Yes No If Yes , identify ( name of person ) and ( C ity and S tate ) t hey are currently living in. 14. (Check only if applicable.) I request a change in the current tax exemption because of the reallocation of the costs of raising the dependent children , pu rsuant to 247 14 - 10 - 115 ( 1 2 ) , C.R.S. American LegalNet, Inc. www.FormsWorkFlow.com JDF 1403 R 2 - 1 8 VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO 24714 - 10 - 122, C.R.S. Page 3 of 3 I respectfully request that this Court enter an Order modifying the Co - child support obligation as described above. By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. SIGNATURE (Print name of Petitioner or Co - Petitioner/Respondent Signature of Petitioner or Co - Petitioner/Respondent Date City State Zip Code (Area Code) Telephone Number (home) (Area Code) Telephone Number (work) CERTIFICATE OF SERVICE I certify that on (date) a true and accurat e copy of the V erified Motion to Modify Child Support was served on the other party by: Hand Delivery , E - filed, Faxed to this number: , or by placing it in the United States mail, postage pre - paid, and addressed to the followin g: To: Your signature If the Child Support Enforcement Unit is invol ved in the case ; you must provide them a copy of this Motion. American LegalNet, Inc. www.FormsWorkFlow.com