Type or Print Clearly JUDICIAL BRANCH - SUPERIOR COURT County Case No. Case Name PETITION FOR MODIFICATION - CHILD SUPPORT 1. Your Name Residence Address Date of Birth Town/City 2. County Other Party's Name Residence Address State Date of Birth Town/City County State 3. What type of case resulted in the present support order (divorce, paternity action, etc.)? And, what court issued the order? 4. What is the present support order (date of support order and amount)? 5. Children for whom support is presently ordered: CHILD NAME 6. DATE OF BIRTH Reason for Request for Modification (check one or both): It has been 3 years since the last court order concerning the amount of support. There has been a substantial change of circumstances, as follows (be specific): SC-PetModCS-WEB03 American LegalNet, Inc. www.USCourtForms.com Petition for Modification-Child Support 7. Pg. 2 of 2 Please check one of the following regarding public assistance. No public assistance (AFDC/TANF) is now being or has within the last 6 months been provided, nor is medical assistance (Medicaid) presently being provided, for any minor child listed in Paragraph 5. The N.H. Department of Health and Human Services is providing or has provided within the last 6 months public assistance (AFDC/TANF) and/or medical assistance (Medicaid) for any minor child. If this is checked, you must mail copies of this petition and the confidential data sheet to the Department at: OCS Legal Office 6 Hazen Drive Concord, NH 03301 8. By filing this petition, you are asking that the Court: A. Modify the present support order. B. Grant any other orders which may be appropriate. Date Signature (Sign in front of Notary Public or Justice of the Peace) Attorney (if any) Attorney's Address State of New Hampshire County The person signing this petition appeared and signed it before me and took oath that the statements in this petition are true, to the best of his or her knowledge and belief, and that he/she has mailed copies of the petition and confidential data sheet to OCS (if required under Paragraph 7). Date Notary Public / Justice of the Peace American LegalNet, Inc. www.USCourtForms.com SC-PetModCS-WEB03