FAMILY COURT MOTION AND DECLARATION ________JUDICIAL CIRCUIT TO MODIFY CHILD SUPPORT STATE OF HAWAI‘I CASE NUMBER FC- NO. [ ] CHILD SUPPORT ENFORCEMENT AGENCY, STATE OF HAWAI‘I, and This document was prepared by: [ ] Petitioner/Plaintiff [ ] Defendant, [ ] Attorney for [ ]Petitioner/Plaintiff [ ]Defendant [ ] MOTHER Name [ ] FATHER PETITIONER(S)/ PLAINTIFF(S), Address vs. City, State, Zip Code [ ] MOTHER [ ] MOTHER [ ] FATHER [ ] FATHER [ ] CARETAKER [ ] CARETAKER [ ] and CHILD SUPPORT ENFORCEMENT AGENCY, STATE OF HAWAI‘I, DEFENDANT(S). Telephone Number ATTACHMENTS: [ ] FINANCIAL INFORMATION SHEET [ ] INCOME/EXPENSE AND ASSET/DEBT STATEMENTS [ ] CHILD SUPPORT GUIDELINES WORKSHEET [ ] COPY OF LAST THREE (3) PAY STUBS [ ] OTHER [X] HEARING SCHEDULING ORDER I am the [ ]Mother [ ]Father [ ]Caretaker in this case. I am referred to as the Movant in this motion. The other party(ies) is/are referred to as Respondent(s) in this Motion. This Motion is made pursuant to Rule 7 of the Hawai‘i Family Court Rules and Rules of the Circuit Courts. The following statements are made in support of this Motion: 1. CHILD(REN) INVOLVED IN THIS REQUEST FOR CHILD SUPPORT MODIFICATION: (Name and birth date of each child) 2. DATE THE LAST CHILD SUPPORT ORDER WAS FILED: 3. CHILD SUPPORT/MEDICAL COVERAGE MODIFICATION REQUESTED: [ ] Child support should be (check one): [ ]increased [ ]decreased [ ]terminated [ ]suspended. [ ] Medical coverage for the child(ren) should be provided by [ ]Mother [ ]Father. [ ] Other: 4. THIS CHANGE IS REQUESTED BECAUSE: (Check all that apply) [ ]4A. A ten percent (10%) increase or decrease occurred in the Child Support Guidelines amount since the existing child support order went into effect. [ ]4B. There is a need to provide for health care for the child(ren). [ ]4C. Three (3) years have passed from the prior child support order and I am requesting a review and an adjustment of that order. [ ]4D. I am currently unemployed because of the following reason: . [ ]4E. Significant changes of circumstances of either a parent or the child(ren) has/have occurred as follows: . I declare under penalty of perjury of law that the foregoing is true and correct. DATE SIGNATURE FO R CO URT USE ON LY 01/2005 M OT ION AND DECLARAT ION T O M OD IFY CH ILD SUPPORT American LegalNet, Inc. www.FormsWorkflow.com