CSD1002 State ENG Rev 5/18www.mncourts.gov/formsPage 1 of 3State of Minnesota District Court County of:Select County Judicial District: Court File Number: Case Type: Petitioner (first, middle, last) and Respondent (first, middle, last) In Re the Marriage of: Intervenor Response to Motion To Modify Medical Support ONLYNoticeTo: Other Party: First Middle Last Street Address Apt. No. City State Zip CodePLEASE TAKE NOTICE that at the hearing scheduled on (Date of hearing)at (Time) o'clock (a.m./p.m.)before the Honorable (Name of Judge or Referee)at the (Name of building where hearing to be held)County Courthouse or Government Center,by filing this responsive motion, I am asking the court for the following relief. MotionRegarding the support order dated (Date of current order), I request that the court (check one): a. should not modify the medical support order. American LegalNet, Inc. www.FormsWorkFlow.com CSD1002 State ENG Rev 5/18www.mncourts.gov/formsPage 2 of 3b. Should modify the medical support order by ordering the following (check all that apply): Requiring the other parent to provide medical and/or dental insurance coverage for the joint children due to a change in the availability of coverage or a change in eligibility for medical assistance. Requiring me to provide medical and/or dental insurance coverage for the jointchildren due to a change in the availability of coverage or a change in eligibility for medical assistance. Changing the amount the other parent pays towards the coverage I carry for thejoint children due to a substantial change in the cost of coverage. Changing the amount I pay to the other parent who provides the coverage for the joint children due to a substantial change in the cost of coverage. Changing which party is ordered to provide medical and/or dental coverage because the party ordered to provide coverage has not done so. Changing or awarding the tax dependency exemption for the joint children to to the parent ordered to carry medical and/or dental insurance coverage.The facts upon which I base my request are set forth in the attached Affidavit in Support of Responsive Motion. Acknowledgments by Party Making Motion a.I am not serving or filing this document for any improper purpose, such as to harass or tocause unnecessary delay or needless increase in the cost of litigation.b.The claims, defenses, and other legal contentions therein are warranted by existing law orby a nonfrivolous argument for the extension, modification, or reversal of existing law orthe establishment of new law.c.The allegations and other factual contentions have evidentiary support or, if specificallyso identified, are likely to have evidentiary support after a reasonable opportunity forfurther investigation or discovery.d.The denials of factual contentions are warranted on the evidence or, if specifically soidentified, are reasonably based on a lack of information or belief.e.The court may impose an appropriate sanction upon the attorneys, law firms, or partiesthat violate the above stated representations to the court, or are responsible for theviolation.f.I understand that the existing order remains in full force and effect and I must continue tocomply with that order until a new order is issued. American LegalNet, Inc. www.FormsWorkFlow.com CSD1002 State ENG Rev 5/18www.mncourts.gov/formsPage 3 of 3 Dated: Signature Name: Address: City/State/Zip: Telephone: E-mail address: Attorney for: American LegalNet, Inc. www.FormsWorkFlow.com