SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT Paternity & Support Branch DISTRI CT OF COLUMBIA EX REL. ________________________________________ ________________________________________ PRINT CHILD(REN)’S NAME(S) OFFICE OF THE ATTORNEY GENERAL FOR DC CHILD SUPPORT ENFORCEMENT DIVISION 441 4TH STREET NW, 5TH FLOOR NORTH WASHINGTON, DC 20001 PETITIONER, v. PS _____________________ IV-D _____________________ Judge _____________________ Related Cases: ________________________________________ PRINT THE OTHER PARENT’S NAME _____________________________ ________________________________________ STREET ADDRESS _____________________________ ________________________________________ CITY, STATE AND ZIP CODE RESPONDENT MOTION TO INTERVENE IN CHILD SUPPORT CASE Does the Office of the Attorney General Consent to this Motion? yes Does the Respondent Consent to this Motion? yes no I, _________________________________, am the PRINT YOUR NAME MOTHER OF THE CHILD(REN) FATHER OF THE CHILD(REN) OTHER _________________ no in this case. 1. This Court has the authority to decide my request to intervene as a Petitioner in this case. 2. A support order was entered in this case on _____________________________________. PRINT DATE OF ORDER DC Bar Pro Bono Program (revised 03.05) Motion to Intervene in Child Support Case Page 1 of 8 American LegalNet, Inc. www.FormsWorkFlow.com 3. That support order requires [CHECK ALL THAT APPLY] that the Respondent pay current child support in the amount of $_______________. Monthly Semi-monthly (twice each month) Bi-weekly (every two weeks) Weekly that the Respondent pay past due child support in the amount of $_______________. Monthly Semi-monthly (twice each month) Bi-weekly (every two weeks) Weekly that the Respondent provide medical support in this way: ________________________________________________________________________ ________________________________________________________________________ other: ________________________________________________________________________ ________________________________________________________________________ 4. The support order was entered for the following child(ren) that I have with the Respondent (through birth or adoption): Child’s Name DC Bar Pro Bono Program (revised 03.05) Current Address Date of Birth Gender Motion to Intervene in Child Support Case Page 2 of 8 American LegalNet, Inc. www.FormsWorkFlow.com 5. I have an interest in this case that is not adequately protected by the existing parties, and resolution of the case without me may impair or impede my ability to protect my interest. 6. I state the following about Temporary Assistance to Needy Families (TANF): [CHECK ONE] I am currently receiving Temporary Assistance to Needy Families (TANF). I am not currently receiving Temporary Assistance to Needy Families (TANF). 7. I state the following about Medicaid and DC Healthy Families: [CHECK ONE] I am currently receiving Medicaid and/or DC Healthy Families. I am not currently receiving Medicaid and/or DC Healthy Families. Response of District of Columbia (Optional) TO SPEED UP A DECISION ON THIS MOTION TO INTERVENE: BEFORE FILING IT WITH THE PATERNITY & SUPPORT CLERK’S OFFICE, TAKE IT TO THE CHILD SUPPORT ENFORCEMENT DIVISION OF THE OFFICE OF THE ATTORNEY GENERAL FOR DC (OAG/CSED) AT 441 4TH STREET NW, SUITE 650 NORTH, WASHINGTON, DC 20001, FOR COMPLETION OF THIS SECTION. ____ The District of Columbia CONSENTS to the request to intervene as Petitioner, but REMAINS as Petitioner in this case with respect to any amounts owed to the District of Columbia for child or medical support. ____ The District of Columbia OPPOSES this request to intervene for the following reason(s): ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. __________________________________________ SIGNATURE OF OAG/CSED REPRESENTATIVE __________________________________________ PRINT NAME OF OAG/CSED REPRESENTATIVE DC Bar Pro Bono Program (revised 03.05) Motion to Intervene in Child Support Case Page 3 of 8 American LegalNet, Inc. www.FormsWorkFlow.com Request for Relief I RESPECTFULLY REQUEST that the Court grant me permission to intervene as a Petitioner in this case. I ALSO REQUEST that the Court award any other relief it considers fair and proper. I DO request an oral hearing in front of the judge on this motion. DO NOT Respectfully Submitted, ____________________________________ SIGN YOUR NAME ___________________________________________ STREET ADDRESS ___________________________________________ CITY, STATE AND ZIP CODE ___________________________________________ TELEPHONE NUMBER SUBSTITUTE ADDRESS: CHECK BOX IF YOU HAVE WRITTEN SOMEONE ELSE’S ADDRESS AND PHONE NUMBER BECAUSE YOU FEAR HARASSMENT OR HARM. DC Bar Pro Bono Program (revised 03.05) Motion to Intervene in Child Support Case Page 4 of 8 American LegalNet, Inc. www.FormsWorkFlow.com POINTS AND AUTHORITIES IN SUPPORT OF MOTION TO INTERVENE In support of this Motion, I refer to: 1. Super. Ct. Dom. Rel. R. 7(b) and 24(a) (2003). 2. The record in this case. 3. The attached supporting document(s), if any. [LIST ANY DOCUMENTS THAT YOU ARE ATTACHING] __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ _________________________________________________________________. DC Bar Pro Bono Program (revised 03.05) Motion to Intervene in Child Support Case Page 5 of 8 American LegalNet, Inc. www.FormsWorkFlow.com ORDER Upon consideration of the above-captioned Motion to Intervene in Child Support Case, any and all supporting argument and documentation provided, and the record herein, it is this _____________ day of _____________________, 20_______ hereby ORDERED that ____ The Motion is GRANTED. Petitioner. The case caption shall be amended to include this ____ The Motion is DENIED. SO ORDERED. ____________________________ ______________________________ DATE JUDGE’S SIGNATURE Copies to: _________________________________ _________________________________ PETITIONER OR PETITIONER’S ATTORNEY RESPONDENT OR RESPONDENT’S ATTORNEY ________________________________________ STREET ADDRESS _______________________________________ STREET ADDRESS ________________________________________ CITY, STATE AND ZIP CODE _______________________________________ CITY, STATE AND ZIP CODE _________________________________ _________________________________ OFFICE OF THE ATTORNEY GENERAL OTHER PARTY IN THIS CASE ________________________________________ STREET ADDRESS _______________________________________ STREET ADDRESS ________________________________________ CITY, STATE AND ZIP CODE ________________________________________ CITY, STATE AND ZIP CODE DC Bar Pro Bono Program (revised 03.05) Motion to Intervene in Child Support Case Page 6 of 8 American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT ________________________________________ PRINT PETITIONER’S/PLAINTIFF’S NAME PETITIONER/PLAINTIFF, Case No. ___________________ v. _________________________________ PRINT RESPONDENT’S/DEFENDANT’S NAME RESPONDENT/DEFENDANT. RULE 5 CERTIFICATE OF SERVICE IF YOU HAVE ALREADY SERVED THE OTHER PARTY, YOU CAN FILL OUT AND FILE THIS CERTIFICATE OF SERVICE ON THE SAME DAY YOU FILE YOUR PAPERS. IF YOU HAVE NOT ALREADY SERVED THE OTHER PARTY, YOU MUST FILL OUT AND FILE THIS CERTIFICATE OF SERVICE AFTER YOU SERVE THE OTHER PARTY. I certify that I served a copy of my Motion to Intervene to the other party or the other party’s attorney on ____________________________. PRINT DATE OF SERVICE The papers were delivered [CHECK ONE] by handing it to the other party by first class mail to: ________________________________________________________________________ PRINT NAME OF PERSON SERVED WITH PAPERS ________________________________________________________________________ STREET ADDRESS CITY, STATE AND ZIP CODE DC Bar Pro Bono Program (revised 03.05) Motion to Intervene in Child Support Case Page 7 of 8 American LegalNet, Inc. www.FormsWorkFlow.com by fax to: ________________________________________________________________________ PRINT NAME OF PERSON SERVED WITH PAPERS ________________________________________________________________________ FAX NUMBER by leaving a copy at the other party’s workplace with a clerk or person in charge, or because there was no one in charge, by leaving it in a conspicuous place: ________________________________________________________________________ PRINT NAME OF PERSON SERVED WITH PAPERS ________________________________________________________________________ STREET ADDRESS CITY, STATE AND ZIP CODE by leaving a copy at the other party’s home with a person of suitable age and discretion who lives there: ________________________________________________________________________ PRINT NAME OF PERSON SERVED WITH PAPERS ________________________________________________________________________ STREET ADDRESS CITY, STATE AND ZIP CODE _____________________________ _____________________________ SIGN YOUR NAME DATE DC Bar Pro Bono Program (revised 03.05) Motion to Intervene in Child Support Case Page 8 of 8 American LegalNet, Inc. www.FormsWorkFlow.com