STATE OF MICHIGAN THIRD JUDICIAL CIRCUIT WAYNE COUNTY CASE NO. MOTION TO MODIFY SUPPORT ORDER Please print or type information. Plaintiff’s name, address, telephone no., and email address This party is incarcerated and a telephonic hearing is required. Defendant’s name, address, telephone no., and email address This party is incarcerated and a telephonic hearing is required. _______________ __________________ _______________ Prisoner ID # Dept. of Corrections’ Prison Name Prisoner ID # Attorney name, address, phone number AND EMAIL ADDRESS ___________________ Dept. of Corrections’ Prison Name Attorney name, address, phone number and EMAIL ADDRESS This motion is being filed by ___ Plaintiff ___ Defendant . The current child support order provides that child support shall be paid in the amount of $__________ per month. A COPY OF THE SUPPORT ORDER IS ATTACHED. I am requesting that the child support amount be: ___ increased ___ reduced ____ modified as follows: __________________________________________________________________ The change in circumstances is: ___ increase/decrease in income ___ new parenting time/custody order ___ Other: __________________________________________________________________________ I declare that the above statements are true to the best of my information, knowledge and belief. _______________ Date FD/FOC 4035 Motion to Modify Child Support ________________________________________________ Signature of party filing motion 4/12/10 American LegalNet, Inc. www.FormsWorkFlow.com The Financial information Form is for the FOC use only. DO NOT FILE WITH THE COUNTY CLERK. Present this information to FOC Scheduling Office located in room 900 A of the Coleman A Young Municipal Center. FINANCIAL INFORMATION FORM FOR CHILD SUPPORT MODIFICATION I am submitting this Financial Information Form to be considered by the Court in connection with my motion to modify the child support obligation in my case. In the event the Court wishes to contact my employer, I authorize my employer to release my payroll information. I make application to the Wayne County Friend of the Court for continuing child support services under the provisions of the Child Support Enforcement Program as required under Title IV-D. I declare that the statements made in this form are true to the best of my information, knowledge and belief. DATE:_______________ SIGNATURE:__________________________________________________ CASE NUMBER: ________________________ YOUR NAME:____________________________________ YOUR EMAIL ADDRESS: __________________YOUR SOCIAL SECURITY NUMBER:__________________ 1. CHILDREN COVERED BY THIS SUPPORT ORDER: Name Date of Birth Address __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 2. PLEASE CHECK THE FOLLOWING SOURCES OF INCOME THAT YOU RECEIVE: a. Monthly Gross Wages (before deductions) ______________ Occupation: ______________________ ATTACH PAYSTUB Employer Name’s Address Phone number ________________________________________________________________________________________ b. Second Job Gross Wages (before deductions) ______________ Occupation: ______________________ ATTACH PAYSTUB Employer Name’s Address Phone number ________________________________________________________________________________________ FD/FOC 4035 Motion to Modify Child Support 4/12/10 American LegalNet, Inc. www.FormsWorkFlow.com If you do not receive a paystub for your earnings, you must verify under oath that this represents your actual income. The penalties for perjury may apply if you misrepresent your income. 3. Unemployment:__________________________ (amount per week and how long you have been receiving the unemployment. 4. Other sources of income: Please state amount received and for what period (week/month/year) Sub Pay: $_____________________ Stock Dividends: $_____________________ Bonus & Profit Sharing: $_____________________ Rental Property Income: $_____________________ Social Security Benefits: $_____________________ Veteran Benefits: $_____________________ Pension: $_____________________ Disability Income: $_____________________ Spousal Support: $_____________________ Other: $_____________________ 5. PLEASE INDICATE WHETHER YOU PAY ANY INSURANCE PREMIUMS: MEDICAL PREMIUMS DENTAL PREMIUMS: OPTICAL PREMIUMS: $_____________________ $_____________________ $_____________________ Individuals Covered by policy Name Age Relationship _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ COURT ORDERED LIFE INSURANCE PREMIUMS________________________ 6. ARE YOU PRESENTLY MARRIED? _________ NAME OF SPOUSE: _______________________ DATE OF MARRIAGE: ___________________ FD/FOC 4035 Motion to Modify Child Support 4/12/10 American LegalNet, Inc. www.FormsWorkFlow.com 7. PLEASE LIST ALL OTHER CHILDREN YOU HAVE: Name Date of Birth Address Indicate: biological/adopted/step __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 8. PLEASE LIST OTHER SUPPORT ORDERS YOU PAY ON – Case number County Current Support Obligation Arrearage Due ______________________________________________________________________________________________ ______________________________________________________________________________________________ 9. DO YOU RECEIVE STATE OR FEDERAL GOVERNMENT ASSISTANCE (i.e. FIA/TANF Assistance)? LIST CASE NUMBER ______________________ CASH GRANT AMOUNT ___________________ MEDICAID: YES OR NO FOOD STAMPS AMOUNT __________________ YOU MUST ATTACH VERIFICATION OF ALL SOURCES OF INCOME AND VERIFICATION OF CHILD CARE EXPENSES IF APPICABLE. FAILURE TO DO SO MAY RESULT IN DISMISSAL OF YOUR MOTION. DATE:____________________ FD/FOC 4035 Motion to Modify Child Support SIGNATURE_____________________________________ 4/12/10 American LegalNet, Inc. www.FormsWorkFlow.com