Nebraska State Court Form DC 6:14(12) NEW Neb. Rev. Stat. 247 42-364, Neb. Ct. R. 247 4-217 ORDER FOR MODIFICATION OF CHILD SUPPORT Page 1 of 4 Order for Modification Child Support DC 6:14(12) New IN THE DISTRICT COURT OF COUNTY, NEBRASKA (county where the original action was filed) , (name of the plaintiff in original action) Plaintiff, vs. , , (name of the defendant(s) in original action)Defendant(s). Case No. (case number in original action) ORDER FOR MODIFICATION (CHILD SUPPORT) This matter came before the County District Court on (county where the original action was filed) , for a hearing on the plaintiff222s, defendant222s (date of the hearing) Complaint for Modification of Child Support. The plaintiff, defendant in the original case is the complainant in this action and appeared in court without an attorney. was, was not present and was, was not (name of other party) represented by counsel . (name of the other party222s attorney) The court heard testimony and received exhibits into evidence. Based on all of the evidence before the court, the court finds as follows: Findings of Fact: 1.The plaintiff, defendant filed the Complaint for Modification of Child Support on . (date that you filed the Complaint for Modification) The plaintiff, defendant:was personally served with a copy of the Complaint on . OR signed a Voluntary Appearance which was filed with the court on . (The clerk of the district court will enter this date) American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 4 Order for Modification of Child Support DC 6:14(12) New 3.The court has jurisdiction over the parties as well as authority to address the subject matter presented inthe Complaint.4.The parties have child(ren) whose welfare is affected by this modification (number of children) 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) 5.There has been a material change in the plaintiff222s, defendant222s circumstances since the date the most recent order for support was entered. Application of the Nebraska Child Support Guidelines wouldresult in a change to the previously ordered child support obligation by more than 10% and result in amonthly dollar difference of $25.00 or more. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 4 Order for Modification of Child Support DC 6:14(12) New The change in circumstances has lasted three months or more and reasonably can be expected to lastforanother six months.(Number 7 is to be completed by the district court judge.)One or both parents do do not have health insurance available to them, through their employer, atareasonable cost.The plaintiff defendant is is not able to provide cash medical support. Neb. Ct. R. 247 4-215. Based on these findings, the court enters the following order: (This section is to be completed by the district court judge.) 1.Pursuant to the Nebraska Child Support Guidelines, child support payments by are to be paid on the 1st day of(name of payor), by the plaintiff, defendant and continue on the first day ofeach 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) A worksheet showing the calculations under the Nebraska Child Support Guidelines is attached to this Order. 2.Child support payments shall be made to the Nebraska Child Support Payment Center, P.O. Box 82600,Lincoln NE 68501-2600.3.This Order shall remain in full force and effect until the minor child(ren) reaches/reach the age of 19,marries or dies, is emancipated or until further order of this court. American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 4 Order for Modification of Child Support DC 6:14(12) New Health Insurance/Cash Medical SupportThe plaintiff, defendant shall provide health insurance coverage for the minor child(ren) as apolicy is available through their employer at a reasonable cost, within the meaning of Neb. Ct. R. 247 4-215ofthe Nebraska Child Support Guidelines.The plaintiff, defendant shall pay the amount of $ per month as cash medicalsupport for the minor child(ren). The plaintiff, defendant is unable at this time to provide health insurance for the minor childrenbecause it is not available at a reasonable cost through an employer, within the meaning of Neb. Ct. R. 2474-215 of the Nebraska Child Support Guidelines. Likewise, the plaintiff, defendant is unable tomake a monthly cash medical support payment because a requirement for cash medical support wouldput them below the federal poverty guidelines. 5.All other provisions of this court222s Order entered , (date of the most recent order setting child support) not specifically modified herein shall remain in full force and effect. Date: District Court Judge American LegalNet, Inc. www.FormsWorkFlow.com