SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT ________________________________________ ______ DRB _______ PRINT PLAINTIFF’ S NAME PLAINTIFF/PETITIONER, ______ PCS _______ v. ______ SUP _______ _________________________________ IV-d ______________ PRINT DEFENDANT’ S NAME Judge _____________ DEFENDANT/RESPONDENT. MOTION TO MODIFY CHILD SUPPORT ORDER Does the Other Party Consent to this Motion?  yes  no I, _________________________________, am the  P LAINTIFF/PETITIONER PRINT YOUR NAME in this case.  D EFENDANT/RESPONDENT 1. This Court is the proper place to decide my request to modify support. 2. A support order was entered in this case on _____________________________________. PRINT DATE OF ORDER 3. That support order requires: [CHECK ALL THAT APPLY]  that _____________________ pay current child support in the amount of $________. PRINT NAME OF PERSON PAYING [CHECK ONE ]     Monthly Semi-monthly (twice each month) Bi-weekly (every two weeks) Weekly DC Bar Pro Bono Program (revised 12.09) Motion to Modify Child Support Order Page 1 of 7 American LegalNet, Inc. www.FormsWorkFlow.com  that _____________________ pay past due child support in the amount of $_______. PRINT NAME OF PERSON PAYING [CHECK ONE ]     Monthly Semi-monthly (twice each month) Bi-weekly (every two weeks) Weekly  that the other party provide medical support in this way: ________________________________________________________________________ ________________________________________________________________________  that I provide medical support in this way: ________________________________________________________________________ ________________________________________________________________________  other: ________________________________________________________________________ ________________________________________________________________________ 4. The support order was entered for the following child(ren) that I have with the other party (through birth or adoption): Child’s Name DC Bar Pro Bono Program (revised 12.09) Current Address Date of Birth Gender Motion to Modify Child Support Order Page 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com 5. Since the support order was entered, there has been a substantial and material change in the needs of the child(ren) and/or in the noncustodial parent’s ability to pay because [CHECK A LL THAT APPLY ]  I am no longer employed. I have not been employed since ____________________. PRINT DATE  I am earning less now than I was earning when the child support order was entered. My current employer is _______________________________________________. I now earn $ ________________________ per ____________.  I am currently disabled and unable to work.  I am currently incarcerated and I state the following about my incarceration: INMATE ID NUMBER ________________________________________________ CASE N AME AND NUMBER ________________________________________________ COURT NAME AND LOCATION ________________________________________________ PLACE OF INCARCERATION ________________________________________________ START DATE ________________________________________________ ANTICIPATED END D ATE ________________________________________________  I am currently supporting my other child(ren) (through birth or adoption):  living in my home CHILD’ S NAME DATE OF B IRTH ____________________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________  through court-ordered child support payments: CHILD’ S NAME DATE OF B IRTH COURT NAME & CASE NUMBER ____________________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ DC Bar Pro Bono Program (revised 12.09) Motion to Modify Child Support Order Page 3 of 7 American LegalNet, Inc. www.FormsWorkFlow.com  The other parent is earning more than s/he was earning when the support order was entered.  The child(ren)’s expenses have changed in this way: _________________________ __________________________________________________________________  The following child(ren) is (are) not living with the other party: ______________________________________________________________________ PRINT CHILD (REN)’ S NAME( S)  The following child(ren) is (are) no longer living: ______________________________________________________________________ PRINT CHILD (REN)’ S NAME( S)  The following child(ren) is (are) over 21 years of age: ______________________________________________________________________ PRINT CHILD (REN)’ S NAME( S)  The following child(ren), although under 21 years of age, is (are) emancipated because of self-supporting employment, active military duty and/or marriage: ______________________________________________________________________ PRINT CHILD (REN)’ S NAME( S)  Application of the child support guideline to the current circumstances of the parents results in a presumptive child support order that varies from the current child support order by 15% or more.  There has been a change in the availability and/or cost of medical insurance for the child(ren).  Other: __________________________________________________________________ __________________________________________________________________ 6. I state the following about Temporary Assistance to Needy Families (TANF): [CHECK ONE]  I am  (TANF). I am not currently receiving Temporary Assistance to Needy Families 7. I state the following about Medicaid and/or DC HealthCare Alliance: [CHECK ONE]  I am  I am not currently receiving Medicaid and/or DC HealthCare Alliance. DC Bar Pro Bono Program (revised 12.09) Motion to Modify Child Support Order Page 4 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Request for Relief I RESPECTFULLY REQUEST that the Court [CHECK ALL THAT APPLY ]:  Hold a hearing on this Motion within 45 days of filing and issue a Notice of Hearing  and Order Directing Appearance (“NOHODA”) to the other party with the date and time of the hearing.  DECREASE the child and/or medical support order according to the Child Support Guideline of the District of Columbia.  INCREASE the child and/or medical support order according to the Child Support Guideline of the District of Columbia.  SUSPEND the child and/or medical support order for a specific period of time.  TERMINATE the child and/or medical support order.  Other ______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ I ALSO REQUEST that the Court award any other relief it considers fair and proper. Respectfully Submitted, ____________________________________ SIGN YOUR NAME ___________________________________________ STREET ADDRESS ___________________________________________ CITY , STATE AND ZIP C ODE ___________________________________________ TELEPHONE NUMBER  SUBSTITUTE ADDRESS: CHECK BOX IF Y OU H AVE WRITTEN SOMEONE E LSE’S ADDRESS AND PHONE N UMBER BECAUSE YOU FEAR HARASSMENT OR HARM. DC Bar Pro Bono Program (revised 12.09) Motion to Modify Child Support Order Page 5 of 7 American LegalNet, Inc. www.FormsWorkFlow.com POINTS AND AUTHORITIES IN SUPPORT OF MOTION TO MODIFY CHILD SUPPORT ORDER In support of this Motion, I respectfully refer the Court to: 1. D.C. SCR-Dom. Rel. R. 7(b) (2009). 2. D.C. Code §§ 16-916.01(r), 16-916.01(t) and 46-204(a) (2009). 3. The record in this case. 4. The attached supporting document(s), if any. [LIST ANY DOCUMENTS THAT YOU ARE A TTACHING] __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ _________________________________________________________________. DC Bar Pro Bono Program (revised 12.09) Motion to Modify Child Support Order Page 6 of 7 American LegalNet, Inc. www.FormsWorkFlow.com RULE 4 (a)(2) and DC CODE § 46-206 CERTIFICATE OF SERVICE WHEN YOU FILE YOUR MOTION TO MODIFY, THE FAMILY COURT CENTRAL INTAKE CENTER WILL ISSUE A NOTICE OF HEARING AND O RDER D IRECTING A PPEARANCE (NOHODA) THAT YOU MUST SERVE ON THE OTHER PARTY WITH A COPY OF YOUR M OTION. YOU MUST SERVE THE OTHER PARTY BEFORE THE HEARING DATE GIVEN ON YOUR NOHODA. HERE ARE THE NOHODA: WAYS YOU CAN SERVE THIS MOTION TO MODIFY AND THE by having someone else, who is over 18 years old and not a party to the case (NOT you), hand it to the other party; or by having someone else, who is over 18 years old and not a party to the case (NOT you), leave a copy at the other party’s home with a person of suitable age and discretion who lives there; or by having someone else, who is over 18 years old and not a party to the case (NOT you), leave a copy at the other party’s workplace with a person of suitable age and discretion; or  by mailing it to the other party by certified mail, return receipt requested and by first-class mail on the same day. IF THE RETURN RECEIPT (“GREEN CARD”) COMES BACK TO YOU, AND IT IS SIGNED BY THE OTHER PARTY OR BY A PERSON OF SUITABLE AGE AND DISCRETION WHO LIVES WITH THE OTHER PARTY, FILE IT WITH THE F AMILY COURT CENTRAL INTAKE CENTER . IF THE RETURN RECEIPT (“ GREEN CARD”) DOES NOT COME BACK TO YOU, BUT THE FIRST CLASS MAIL ALSO DOES NOT COME BACK TO YOU, THE SERVICE IS STILL OKAY. AFTER YOU SERVE THE OTHER PARTY, YOU MUST COMPLETE THE CERTIFICATE OF SERVICE PORTION FOUND AT THE BOTTOM OF THE NOHODA AND FILE IT WITH THE FAMILY C OURT CENTRAL INTAKE CENTER. DC Bar Pro Bono Program (revised 12.09) Motion to Modify Child Support Order Page 7 of 7 American LegalNet, Inc. www.FormsWorkFlow.com