STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov MOTION FOR MODIFICATION JD-FM-174 Rev. 8-08 C.G.S. § 46b-86, P.B. §§ 25-26, 25-30, 25-57, 25-65 COURT USE ONLY MFMOD (Check one) Before judgment After judgment (If the court has ordered you to attach a request for leave with a motion for modification of a final custody or visitation order, you must complete and attach a Request for Leave form (JD-FM-202) to this motion ) Judicial District of At (Town) Docket Number Case Name Type of Motion to Modify Child Support Alimony I Custody Other (Specify): , residing at (Name) am the Visitation Defendant Plaintiff and I respectfully represent that: 1. This Court issued an order dated , residing at directing (Name) (Number, street, city, state, zip code) (Complete the boxes that apply to your motion) Pay Child Support in the Amount of: , (Number, street, city, state, zip code) to: Pay Alimony in the Amount of: Have Custody of the Child/Children: (Check one) Joint Sole Per Per Have Visitation or Parenting Time as Follows: (Attach a copy of the visitation schedule if available) Primary Residence with: Other: 2. (Check appropriate box(es) and explain briefly why you are seeking a modification) Since the date of the order, the circumstances concerning this case have changed substantially as follows: The final order for child support is substantially different from the Child Support Guidelines as follows: I ask the Court to modify the current order as follows: (Check all that apply) Child Support Increase Alimony Decrease the amount of child support to be paid. Order immediate income withholding. (You must file a Financial Affidavit (JD-FM-6) at least 5 days before the hearing. You must also file an Advisement of Rights Re: Income Withholding (JD-FM-71)). Increase Custody (You must file a Financial Affidavit (JD-FM-6) at least 5 days before the hearing. You must also file an Affidavit Concerning Children (JD-FM-164), a completed child support and arrearage guidelines worksheet (CCSG-1), and an Advisement of Rights Re: Income Withholding (JD-FM-71)). Decrease the amount of alimony to be paid. (You must file a Financial Affidavit (JD-FM-6) at least five (5) days before the hearing. You must also file an Affidavit Concerning Children (JD-FM-164) and a completed child support and arrearage guidelines worksheet (CCSG-1)). Modify custody as follows: Visitation (You must file a Financial Affidavit (JD-FM-6) at least five (5) days before the hearing. You must also file an Affidavit Concerning Children (JD-FM-164) and a completed child support and arrearage guidelines worksheet (CCSG-1)). Modify visitation (parenting time) as follows: Other (Please be specific): Signature Print Name Address (Number, street, city, state, zip code) (Continued on back/page 2) Date Signed Telephone (Area code first) Check appropriate court: Superior Court Family Support Magistrate Division American LegalNet, Inc. www.FormsWorkflow.com Plaintiff's Name (Last, first, middle initial) Defendant's Name (Last, first, middle initial) Docket Number NOTE: If you are now or have ever been a recipient of state assistance, you must send a copy of this motion to: The Office of the Attorney General, 55 Elm Street, Hartford, CT 06106 Certification I certify that I mailed or delivered a copy of this motion to: Name* Date Mailed or Delivered Address (Number, street, city, state, zip code)* Signature Print Name Date Signed *If necessary, attach additional sheet with name of each party served and the address at which service was made. Order For Hearing and Summons (To be completed by clerk, if applicable) The Court orders that a hearing be held at the time and place shown below. The Court also orders the Plaintiff Defendant to give notice to the opposing party of the Motion and of the time and place where the court will hear it, by having a true and attested copy of the Motion and this Order served on the opposing party by any proper officer at least 12 days before the date of the hearing. Proof of service must be made to this Court at least six days before the date of hearing. Hearing to be held at Superior Court, Judicial District of Date Court Address Room Number Time To any proper officer: By the Authority of the State of Connecticut, you must serve a true and attested copy of the above Motion and Order For Hearing on the below named person in one of the ways required by law at least 12 days before the date of the hearing, and file proof of service with this Court at least six days before the hearing. Person to be Served Address By the Court Assistant Clerk Date Signed Order The court has heard this motion and orders it Granted. Denied. By the Court (Judge/F.S.M./ Assistant Clerk) Date Ordered For Court Use Only Fee for Motion to Modify: Paid Waived JD-FM-174 (Back/Page 2) Rev. 8-08 American LegalNet, Inc. www.FormsWorkflow.com