IN THE CIRCUIT COURT OF JACKSON COUNTY MISSOURI AT KANSAS CITY AT INDEPENDENCE ___________________________________________________ Name, D/O/B, Social Security Number PETITIONER, Address:____________________________________________ ___________________________________________________ VS. CASE NO.___________________________________ ___________________________________________________ Name, D/O/B, Social Security Number RESPONDENT. Address:____________________________________________ ___________________________________________________ AFFIDAVIT FOR TERMINATION OF CHILD SUPPORT AND MODIFICATION I, _________________________________________, am receiving support paying support on this case for the following child ________________________________, whose date of birth and social security number is________________________________, and is no longer entitled to support for the following reasons: [Check all that apply] The child died on _________________________________ (attach certified copy of death certificate). The child married on _______________________________ (attach certified copy of marriage license). The child entered active duty in the military on ____________________________ (attach verification). The child has become self-supporting, and the custodial parent has relinquished the child from parental control by express or implied consent. The child has attained the age of 21. The child has attained the age of 18 and is not physically or mentally incapacitated from supporting himself or herself, and the child’s circumstances do not manifestly dictate that child support should continue. has not graduated from secondary school or completed a graduation equivalence degree program and, upon reaching age 18, was not attending and progressing toward completion of a secondary school program of instruction. has graduated from secondary school or completed a graduation equivalence degree program but did not enroll in an institution of vocational or higher education by October 1 following graduation or completion of the graduation equivalence degree program. has enrolled in an institution of vocational or higher education by October 1 following graduation from secondary school or completion of a graduation equivalence degree program, but has completed his or her education, failed to achieve grades sufficient to re-enroll at such instituion, or failed to complete twelve credit hours in each semester. has failed to submit a transcript or similar official document including grades, courses and credit hours at the beginning of the semester to the non-custodial parent. has failed to produce the documentation within 30 days of the receipt of grades for the educational institution, as requested by the non-custodial parent. the child, when enrolled in at least 12 credit hours of post secondary education, has failing grades in half or more of the child’s course load in any one semester. I further request that the total amount of child support to be paid be modified, for the following child or children: (list date of birth and social security number for each child): ___________________________________________ __________________________________________________________________________________________. The current non-custodial parent has a wage assignment with________________________________, located at ________________________________________. The facts in this Affidavit are true to my best knowledge and belief and are made under penalty of perjury pursuant to Section 509.030, RSMo. _____________________________________________ _____________________________________ Date Signature of Parent American LegalNet, Inc. SEE REVERSE SIDE FOR IMPORTANT INFORMATION www.FormsWorkflow.com NOTICE TO PARENT RECEIVING SUPPORT If you agree with statements in this Affidavit and agree to termination of the obligation to pay support for the child, you may, but are not required to, file an Acknowledgement with the Court. Upon your filing of an Acknowledgement, a judgment terminating the obligation to pay support for the child will be entered. If you disagree with the statements in this Affidavit and object to termination of the obligation to pay support for the child, you must file with the Court an Answer which states the reasons the obligation to pay support for the child should continue. Upon your filing of an Answer, the Court will treat this Affidavit as a motion to modify, will schedule an evidentiary hearing, and may require payment of a deposit as security for costs. Your failure to file an Acknowledgment or Answer with the Court within 30 days of your receipt of this Affidavit will result in entry by default of a judgment terminating the obligation to pay support for the child. Please mail your answer to: Jackson County Circuit Court Civil Records Department/Domestic Relations 415 E. 12th Street, 3rd Floor Kansas City, MO 64106 Jackson County Circuit Court Civil Records Department/Domestic Relations 308 W. Kansas, 2nd Floor Independence, MO 64050 You must also mail a copy of your Answer/Acknowledgment to the party who filed the Affidavit. ______________________________________________________________________________________________ CERTIFICATE OF MAILING OF PARENT RECEIVING SUPPORT If Affidavit is filed by Parent Receiving Support then a copy of the affidavit must be mailed to the other side and this certificate must be completed. I certify that on the ___________ day of ____________________________, I mailed a copy of this Affidavit to the Parent Paying Support at the following address: ________________________________________________________________ _______________________________________________________________________________________________ SHERIFF’S OR SERVER’S RETURN I certify that I served a copy of this Affidavit in______________________________________________ County, Missouri: (1) PERSONAL SERVICE By delivering a copy of the summons and a copy of the affidavit to the parent receiving support ____________________________________________________________________________________ (2) MEMBER OF FAMILY By leaving a copy of the Affidavit at the dwelling place or usual place of abode of the parent receiving support with _________________________________________________________________________ a person of his or her family over the age of 15 years (3) NON-EST By making a diligent search for and failing to find the parent receiving support ______________________ for the reason that:____________________________________________________________________. Served at (address) ___________________________________________________________________________________________ on (date) __________________________________ at (time) ______________________ M. By ________________________________________________________ Sheriff or Server MUST BE SWORN BEFORE A NOTARY PUBLIC IF NOT SERVED BY AN AUTHORIZED OFFICER Subscribed and sworn to before me on ____________________________________________________. (Seal) ______________________________________________________________________________________ Notary Public My Commission Expires: _____________________________________________ Once completed, a copy of this service return should be forwarded immediately to the applicable Jackson County Courthouse, Department of Civil Records, Domestic Relations Section. 07/07 American LegalNet, Inc. www.FormsWorkflow.com