Nebraska State Court Form DC 6:14(5) NEW Neb. Rev. Stat. 247 42-364, Neb. Ct. R. 247 4-217 COMPLAINT FOR MODIFICATION OF CHILD SUPPORT (INCREASE) Page 1 of 2 Complaint for Modification Child Support (increase) DC 6:14(5) New IN THE DISTRICT COURT OF COUNTY, NEBRASKA (county where the original action was filed) , (name of plaintiff in original action) Plaintiff, vs. , , (name of the defendant(s) in original action)Defendant(s). Case No. CI (case number in original action) COMPLAINT FOR MODIFICATION OF CHILD SUPPORT (INCREASE) I, , without the assistance of an attorney, state that the (your full name) following is true: 1.On the court ordered (date of the most recent order setting child support) (name of payor)to pay child support for the below listed child(ren): , born (name of child) (child222s year of birth) , born (name of child) (child222s year of birth) , born (name of child) (child222s year of birth) , born (name of child) (child222s year of birth) Additional children are listed on a separate page. Pursuant to the Nebraska Child Support Guidelines, child support payments were to begin on the 1st day of , and continue (month and year the most recent order setting child support became effective) on the first day of each subsequent month thereafter in the amounts set forth: per month for children (support amount) (number of children) per month for children (support amount) (number of children) per month for children (support amount) (number of children) per month for one child (support amount) American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Complaint for Modification Child Support (increase) DC 6:14(5) New 2.There has been a material change in circumstances since the date the Order was entered.3. is eligible for a Modification of the Child Support Order(name of payee)within the meaning of the Nebraska Child Support Guidelines and Nebraska Statutes.4.Application of the Nebraska Child Support Guidelines to the party(ies) current incomewould increase the monthly child support obligation by 10% or more, and by not lessthan $25 per month.5.The material change in the party(ies) circumstances since the date of themost recent order setting child support is as follows: Check All That Apply 222s employment income has substantially increased. (name of party) 222s employment income has substantially decreased. (name of party) 6.The change in the party(ies) financial circumstances has lasted for three months and canreasonably be expected to last for an additional six months. WHEREFORE, I ask that this court modify the child support obligation entered on , and increase the monthly child support obligation (date of the most recent order setting child support) to an amount consistent with the Nebraska Child Support Guidelines, and for such other relief as the court deems appropriate. Date Signature Name Street Address/P.O. Box E-mail Address City/State/ZIP Code Phone American LegalNet, Inc. www.FormsWorkFlow.com