PRO SE MOTION FOR MODIFICATION OF SUPPORT INSTRUCTIONS THERE MUST BE A CHANGE OF CIRCUMSTANCE FOR THE COURT TO HEAR A MOTION TO MODIFY. You must list one or more in your Motion. Examples of changes in circumstances are: a) Lapse of Time since the last order, and the children are now older and more expensive to support, b) Change in Income (Is one of the parties making more money? Less money?) c) Have daycare or insurance costs changed significantly? 1. Make a copy of the BLANK Domestic Relations Affidavit and the BLANK Employer Verification Form to give to your ex-spouse for their use. 2. Fill out COMPLETELY: (A) Motion (B) Notice of Hearing (The Clerk of the District Court will give you a date and time when you file your motion.) (C) Domestic Relations Affidavit (D) Employer Verification Form – Both parties must have this form completed by their employer. (E) Child Care Verification Form – If Applicable – Must be completed by the child care provider. (F) Request and Service Instruction Form Note: Make sure to provide proof of income by bringing the copies of your TWO (2) most recent paycheck stubs which includes year-to-date totals, and a copy of last years income tax return to court on your court date. 3. File the ORIGINAL and FOUR (4) COPIES of: a) Motion, b) Notice of Hearing, c) Domestic Relations Affidavit including proof of income and attachments, d) Employer Verification Form, e) Child Care Verification form, f) Request and Service Instruction form with the Civil Department. The Clerk of the District Court will “File-stamp” all copies and keep the originals and give you back copies. Civil Department: 9:00 AM – 4:30 PM M-F (3rd Floor Wyandotte County, Kansas Courthouse, 710 North Seventh street, Kansas City, Kansas 66101) You must tell the Clerk on your Request for Service form how you want your Motion served. There are three main ways: a) Certified Mail, b) Personal Service in Wyandotte County by either the Process Service Department or the Wyandotte County Sheriff’s Department, c) Personal Service by Sheriff’s Department in other County of other State. Service: You must now serve a “file stamped” copy of: a) Motion b) Notice of Hearing c) Your Domestic Relations Affidavit with attachments d) Employer Verification Form (yours and the blank one) e) Child Care Verification (if applicable) f) and a BLANK Domestic Relations Affidavit on your ex-spouse and his/her attorney American LegalNet, Inc. www.FormsWorkflow.com SERVICE BY MAIL: Service by mail must be by certified mail. You will need to use a “green card” which you will have to get from the post office. After you receive the green card back signed you will attach it to the return of service for certified mail and file it with the clerk of the District Court. SERVICE BY THE WYANDOTTE COUNTY, KANSAS PROCESS SERVICE DEPARTMENT OF SHERIFF’S OFFICE: The Civil Department will issue the paperwork to the Sheriff’s Office. SERVICE BY A SHERIFF’S OFFICE IN THE STATE OF KANSAS OTHER THAN WYANDOTTE COUNTY: The clerk of the District Court will issue the paperwork to that Sheriff’s Office. SERVICE BY SHERIFF’S OFFICE OURTSIDE THE STATE OF KANSAS: YOU will need to call the Sheriff’s Office in the County where you want service completed and find out the cost for civil service of paperwork. A MONEY ORDER must accompany your paperwork at the time of filing, made out to THAT Sheriff’s Office. The Civil Department will then issue the paperwork and MONEY ORDER to that Sheriff’s Office. IT IS UP TO YOU to get the correct papers filed, and proper service completed, in order for your case to go forward on its assigned hearing date and time. Be advised, the Hearing Officer can dismiss the Motion for lack of proof by either party. IN THE DISTRICT COURT OF WYANDOTTE COUNTY, KANSAS CIVIL COURT DEPARTMENT American LegalNet, Inc. www.FormsWorkflow.com IN THE MATTER OF: _________________________________________ Petitioner And CASE NO.__________________ DIVISION NO._____________ AND CHAPTER 60 _________________________________________ Respondent MOTION FOR ___________________________________ COMES NOW the (Petitioner/Respondent) and moves the Court to change the current Order of the Court and in support of said motion lists the following reasons: (1)___________________________________________________________________________________________ ________________ (2)___________________________________________________________________________________________ ________________ (3)___________________________________________________________________________________________ ________________ Note: BOTH parties are required by Kansas Law to fill out and file a Domestic Relations Affidavit with attached Employer Verification Form, and Child Care Verification Form (if applicable) with the Civil Department, at least 5 days prior to the hearing date. Please bring copies of the most recent paycheck stub with year-to-date totals, and a copy of last year’s income tax return to court on your court date. WHEREFORE, the (Petitioner/Respondent) moves the Court for a change of the current Support Order of the Court. NOTICE OF HEARING Please take notice that the above motion has been set for hearing before the Hearing Officer at the Wyandotte County, Kansas Courthouse, 710 N. Seventh Street, Kansas City, Kansas on: DATE: __________________________________________________________________________ TIME: _______________________________________________________________(A.M./P.M.) (PLACE OF HEARING) DIVISION 18 – SECOND FLOOR Note: BOTH parties are required by Kansas Law to fill out and file a Domestic Relations Affidavit with attached copy of the most recent paycheck stub with year-to-date totals, and a copy of last year’s income tax return, and Employer Verification Form, and Child Care Verification Form (if applicable) with the Civil Department, at least 5 days prior to the hearing date. __________________________________ Your Signature Pro Se Home Address______________________ __________________________________ Daytime Phone #___________________ CERTIFICATE OF MAILING American LegalNet, Inc. www.FormsWorkflow.com To be completed only if you choose service by U.S. Mail-Postage Pre-Paid, to opposing parties at last known address I hereby certify that a true and correct copy of the above and foregoing document was placed in the United States Mail, postage prepaid on this _____day of _____________________, 20___, to the (Petitioner/Respondent/attorney of record address) as follows: _____________________________________________________________________________________________ ________________ _____________________________________________________________________________________________ ________________ _____________________________________________________________________________________________ ________________ _______________________________________ Your Signature Pro Se Home Address___________________________ _______________________________________ Day Time Phone # ________________________ IN THE DISTRICT COURT OF WYANDOTTE COUNTY, KANSAS CIVIL COURT DEPARTMENT IN THE MATTER OF: American LegalNet, Inc. www.FormsWorkflow.com ______________________________________ Petitioner And CASE NO: _____________________ DIVISION NO:_________________ CHAPTER 60 ______________________________________ Respondent REQUEST AND SERVICE INSTRUCTION FORM To: The Clerk of the District Court Please issue a Motion for _____________________________ and Notice of Hearing filed herewith for service on: Name of person to be served: ________________________________________________________________ Address for service is: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ The Clerk of the District Court is hereby instructed to effect service, as follows: _____ 1) Service by U.S. Mail - Postage Pre-Paid, to opposing parties at last known address by the undersigned pro se litigant. _____ 2) Certified mail service by the undersigned pro se litigant, who understands that the responsibility for obtaining service shall be their own. The Return of Service (green card) must be filed with the Clerk of the District Court prior to the Hearing date. _____ 3) Personal Service through the Office of the Sheriff of Wyandotte County, State of Kansas. (party to be served, MUST live/work in Wyandotte County, Kansas) _____ 4) Certified mail service by the Sheriff of Wyandotte County, State of Kansas. (party to be served, must live/work in the State of Kansas) _____ 5) Personal Service (other than Wyandotte County) through the Office of the Sheriff of __________________County, State of __________________. (Money Order made out to THAT Sheriff’s office must accompany paperwork) ________________________________ Your Signature Pro Se Home Address ____________________ ________________________________ Day Time Phone #________________ IN THE DISTRICT COURT OF WYANDOTTE COUNTY, KANSAS CIVIL COURT DEPARTMENT IN THE MATTER OF: American LegalNet, Inc. www.FormsWorkflow.com _______________________________________ Petitioner and CASE NO:___________________ DIVISION NO:_______________ CHAPTER 60 _______________________________________ Respondent RETURN OF SERVICE FOR CERTIFIED MAIL STATE OF KANSAS) COUNTY OF WYANDOTTE) The undersigned pro se litigant being duly sworn, states: I have served a Motion for __________________________ on the(Petitioner/Respondent/attorney of record) and the following Return for Receipt of Service was served by certified mail on_____________________(date) and place as listed on the attached green card. Here is where you will attach the green card once you have received it back by mail from the post office showing that someone has signed for the certified letter. _________Check here (if appropriate) service by certified mail was refused. ________________________________ Your Signature Pro Se Subscribed and sworn to before me on this __________day of ___________________________ My appointment expires: ________________________________ Notary Public DISTRICT COURT OF WYANDOTTE COUNTY, KANSAS CIVIL COURT DEPARTMENT IN THE MATTER OF: American LegalNet, Inc. www.FormsWorkflow.com ____________________________________________ Petitioner CASE NO._______________ DIVISION NO.___________ CHAPTER 60 _____________________________________ Respondent DOMESTIC RELATIONS AFFIDAVIT OF: __________________________________________________ (Name) 1. Mother’s Residence ____________________________________________________________ Mother’s XX-XX-______ _____________________ Soc. Security # XXX-XX-_________ Year of Birth Day Time Telephone 2. Father’s Residence _____________________________________________________________ Father’s XX-XX-_______ ___________________ Soc. Security # XXX-XX-_________ Year of Birth Day Time Telephone 3. Date of Marriage: ________________________ 4. Number of Marriages: ____________ ______________ Mother Father 5. Number of children of the relationship: _________________________ 6. Names, birth dates and ages of minor children of the relationship: Name Year of Birth Age Custodian ______________________ XX-XX-___________ _____________ _______________________ ______________________ XX-XX-___________ _____________ _______________________ ______________________ XX-XX-___________ _____________ _______________________ ______________________ XX-XX-___________ _____________ _______________________ 7. Names, and ages of other minor children of (previous or current) relationships and facts as to custody and support payments paid or received, if any: Previous/ Name Year of Birth Custodian Support Payment Paid/Rec’d Current ___ __________________ XX-XX-______ ____________ $_______________ __________ ___ __________________ XX-XX-______ ____________ _______________ __________ ___ __________________ XX-XX-______ ____________ _______________ __________ ___ __________________ XX-XX-______ ____________ _______________ __________ 8. Mother is employed by _____________________________________________________ _____________________________________________________ Father is employed by ______________________________________________________ ______________________________________________________ (Name and address of employer(s) Monthly income as follows: A. Wage Earner Mother Father 1. Gross Income 2. Other Income $________________ ________________ $________________ ________________ American LegalNet, Inc. www.FormsWorkflow.com 3. Subtotal Gross Income 4. Federal withholding (Claiming ____exemptions) 5. Federal Income Tax 6. OASDHI (Social Security) 7. Kansas Withholding 8. Subtotal Deductions 9. Net Income ________________ ________________ ________________ _________________ _________________ _________________ _________________ _________________ _________________ ________________ ________________ ________________ ________________ ________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ __________________ __________________ __________________ __________________ _________________ _________________ _________________ _________________ B. Self-Employed 1. Gross Income from self-employment 2. Other Income 3. Subtotal Gross Income 4. Federal Withholding (Claiming _____ exemptions) 5. Self-Employment Tax 6. Estimated Tax Payments (Claim _______ exemptions) 7. Federal Income Tax 8. Kansas Withholding 9. Subtotal Deductions 10. Net Income (Line B.3 minus Line B.9) Pay Period: _______________________________ Mother ______________________________ Father Other cases where child support/maintenance is paid/received: State/County Case # Date of Order Amount(s) paid/received child support/maintenance _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 9. How much does the party who provides health care pay for family coverage? _______ # of family members covered. $______________ per ___________________. How much does it cost the provider to furnish health insurance only on the provider? $______________ per ___________________. 10. Income and financial resources of children. Income/Resources __________________________________ Amount $_____________________ American LegalNet, Inc. www.FormsWorkflow.com __________________________________ __________________________________ __________________________________ $_____________________ $_____________________ $_____________________ 11. Child support adjustments requested. Mother Father Long Distance Parenting Time Costs Parenting Time Adjustment Income Tax Considerations Special Needs Agreement Past Majority Overall Financial Condition $__________________ $__________________ $__________________ $__________________ $__________________ $__________________ $________________ $________________ $________________ $________________ $________________ $________________ 12. All other personal property including retirement benefits (including but not limited to qualified plans such as profit sharing, pension, IRA, 401{k}, or other savings-type employee benefits, non-qualified plans, and deferred income plans), and ownership (joint or individual), and actual or estimated value. Amount Joint or Individual (Specify) ___________________________________________ $_____________ $_________________ ___________________________________________ $_____________ $_________________ ___________________________________________ $_____________ $_________________ ___________________________________________ $_____________ $_________________ UNEMPLOYED: Are you receiving Unemployment Compensation? How much $______________week. How many weeks are you eligible for?_______________________________________. SSI or SSD: Are you receiving Social Security Income or Social Security Disability? How much $_________month What date did you start receiving it?________________________ VERIFICATION STATE OF _____________________) COUNTY OF ___________________) I swear or affirm under penalty of perjury that the information presented in this affidavit is true and complete. ______________________________________ Subscribed and sworn this _____day of __________________________, 20____ _______________________________________ Notary Public My Appointment Expires: DISTRICT COURT OF WYANDOTTE COUNTY, KANSAS CIVIL COURT DEPARTMENT American LegalNet, Inc. www.FormsWorkflow.com IN THE MATTER OF: ____________________________________________ Petitioner CASE NO._______________ DIVISION NO.___________ CHAPTER 60 _____________________________________ Respondent EMPLOYER VERIFICATION FORM (BOTH PARTIES MUST HAVE THEIR EMPLOYER COMPLETE THIS FORM) Employee Name _______________________________________________________________________________ Current Home Address __________________________________________________________________________ _____________________________________________________________________________________________ Employer Name _______________________________________________________________________________ Work Location and address _______________________________________________________________________ _____________________________________________________________________________________________ NORMAL PAYMENT PERIOC: (circle one) weekly, every two weeks, semi-monthly, monthly, other (specify) _____________________________________________________________________________________________ HOURLY WAGE GROSS INCOME Itemized all deductions from income Federal income tax State & Local Income tax Federal social security or R.R. retirement tax Other amounts required by law to Be withheld (specify) NET DISPOSABLE INCOME $______________________ $______________________ /Month $______________________ /Month $______________________ /Month $______________________ /Month $______________________ /Month $______________________ /Month $______________________ /Month HEALTH INSURANCE: Does the employee now have health insurance through your company which covers dependent children not living with the employee? YES _____ No _______ If no, Is it available? YES _____ No _______ List dependents claimed under employee’s health insurance _____________________________________________________________________________________________ What is the cost to provide such coverage for the children ONLY? $__________________________ List name of insurance carrier _____________________________________________________________________________________________ _________________________________________________________ ________________________________ Signature and Title of Employer providing above information Date DISTRICT COURT OF WYANDOTTE COUNTY, KANSAS CIVIL COURT DEPARTMENT IN THE MATTER OF: American LegalNet, Inc. www.FormsWorkflow.com ____________________________________________ Petitioner CASE NO._______________ DIVISION NO.___________ CHAPTER 60 _____________________________________ Respondent CHILD CARE VERIFICATION PARENT INFORMATION: Complete the top portion of this form and have your child care provider complete the remainder. Name: _______________________________________________________________________________________ Name(s) and age(s) of child(ran) involved in this case __________________________________________________ _____________________________________________________________________________________________ Are you receiving financial assistance for child care from Federal or State agency? Yes No If yes, please state the agency and the amount you are receiving. _________________________________________ _____________________________________________________________________________________________ CHILD CARE PROVIDER INFORMATION: Please attach a schedule of your most recent child care rates. The child Care Provider must complete the remainder of this form for the above named child(ren). Name of provider: ______________________________________________________________________________ Address: _____________________________________________________________________________________ Name and age of child School Year Rates Avg. No. of Hrs/Wk Hrly Rate Total Wkly Rate ___________________________ $______________ $________________ $____________ $_____________ ___________________________ $______________ $________________ $____________ $_____________ ___________________________ $______________ $________________ $____________ $_____________ ___________________________ $______________ $________________ $____________ $_____________ Name and age of child ___________________________ ___________________________ ___________________________ ___________________________ Sunner Rates $______________ $______________ $______________ $______________ Avg. No. of Hrs/Wk $________________ $________________ $________________ $________________ Hrly Rate $____________ $____________ $____________ $____________ Total Wkly Rate $_____________ $_____________ $_____________ $_____________ Do you require payment for service even when children are absent to guarantee a position in you center? Yes No If yes please explain: ____________________________________________________________________________ Does Federal or State agency contribute all or a portion of these child care services? Yes No THE ABOVE INFORMATION IS PROVIDED TO ENABLE THE DISTRICT COURT TO ACCURATELY REPORT CHILD CARE COSTS IN MAKING A CHILD SUPPORT MODIFICATION. I CERTIFY THAT THE ABOVE INFORMATION IS TRUE, ACCURATE, AND COMPLETE. _______________________________________________________ SIGNATURE AND TITLE OF PROVIDER ____________________________ DATE American LegalNet, Inc. www.FormsWorkflow.com