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Forms For Establishing And Modifying Support Orders - Chapter 1240-2-1 Form. This is a Tennessee form and can be use in Parenting Plan Statewide.
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RULES
OF
TENNESSEE DEPARTMENT OF HUMAN SERVICES
CHILD SUPPORT SERVICES DIVISION
CHAPTER 1240-2-1
FORMS FOR ESTABLISHING AND MODIFYING SUPPORT ORDERS
TABLE OF CONTENTS
1240-2-1-.01
1240-2-1-.02
Petition Form
Affidavit Form
1240-2-1-.03
Notice of Hearing Form
1240-2-1-.01 PETITION FORM. The following form, or another form containing all of the information herein,
may be used to commence an action to establish or modify a support order pursuant to TCA §36-5-401 et seq.
IN THE ________________ COURT OF ______________________ COUNTY, TENNESSEE
___________________________________
Petitioner
)
)
)
)
)
)
)
)
)
vs.
___________________________________
Respondent
Petition
(Check one)
No. _______________
____ To set child support
____ To enforce child support
____ To modify child support
Petitioner, ______________________________, under TCA Title 36, Chapter 5, states:
1.
Petitioner is a resident of ____________________ County, Tennessee, and lives at
________________________________________________________________________________
2.
Respondent is a resident of ___________________, ________________ and lives at
________________________________________________________________________________
3.
The child(ren) for whom support is sought is (are):
(name) ____________________________________
(name) ____________________________________
(name) ____________________________________
4.
(birthdate) _________________________
(birthdate) _________________________
(birthdate) _________________________
This (these) child(ren) reside(s) at ____________________________________________________
5.
Petitioner's relationship to the (these) child(ren) is:
______________________________________________________________________________________
6.
Respondent is obligated to pay support for this (these) child(ren) because: (check appropriate section)
____ (a) respondent is legal part by virtue of birth during marriage to (ex-spouse name)
January, 1986 (Revised)
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FORMS FOR ESTABLISHING AND MODIFYING SUPPORT ORDERS
CHAPTER 1240-2-1
(Rule 1240-2-1-.01, continued)
_________________________________ , on (date of marriage) ______________________
____ (b) court order of __________________________ court on (date) ________________, [copy
attached (may be order of paternity, legitimation, divorce, adoption, nonsupport)].
____ (c) other (specify) ____________________________________________________________
7.
Petitioner seeks to: (check appropriate items a - e)
____ (a) have support set.
____ (b) enforce support.
____ (c) modify support:
____ (1) by increasing support;
____ (2) by decreasing support.
____ (d) recover arrearages due.
____ (e) other (specify) ____________________________________________________________
8.
Respondent has children under the age of 18 other than those listed above. Yes ____ No ____ If
Yes:
(name) ____________________________________
(name) ____________________________________
(name) ____________________________________
(birthdate) _________________________
(birthdate) _________________________
(birthdate) _________________________
9.
Respondent is under an order of support for any other children. Yes ____ No ____
10.
Respondent was previously married. Yes ____ No ____
11.
Respondent has subsequently married. Yes ____ No ____
SO THE PETITIONER REQUESTS:
1.
That a hearing in this cause be set and notice of said hearing be served on Respondent, as provided in
§36-5-405 (a).
2.
That the Court order: [check the appropriate paragraph (a) through (d)]
____ (a) Respondent to pay a reasonable amount of child support in the manner deemed appropriate.
____ (b) Enforcement of the previously ordered child support by means the Court finds to be
appropriate, including but not limited to income assignment, issuance of liens on real and/or
personal property of Respondent, requiring a bond or other security to assure payment.
____ (c) An increase in child support.
____ (d) A decrease in child support.
January, 1986 (Revised)
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FORMS FOR ESTABLISHING AND MODIFYING SUPPORT ORDERS
CHAPTER 1240-2-1
(Rule 1240-2-1-.01, continued)
3.
For general relief.
__________________________________
PETITIONER
)
)
)
STATE OF TENNESSEE
COUNTY OF_________________________
__________________________________, being first duly sworn, affirms that the petitioner has read the foregoing
petition, knows the contents thereof, and that the same is true and correct to the best of petitioner's knowledge,
information, and belief.
__________________________________
PETITIONER
Sworn to and subscribed before me this _______ day of ______________, 19/20 _____.
__________________________________
NOTARY PUBLIC/CLERK
My commission expires: ___________________________________
Authority: PC 477, Acts of 1985; TCA §36-5-406. Administrative History: New rule filed December 17, 1985;
effective January 14, 1986.
1240-2-1-.02 AFFIDAVIT FORM. The following form, or another form containing all of the necessary
information, may be used in conjunction with the form in 1240-2-1-.01 to commence an action to establish or
modify a support order pursuant to TCA, §36-5-401 et seq.:
IN THE _____________ CIRCUIT COURT OF ________________ COUNTY, TENNESSEE
_______________________________
Petitioner
)
)
)
)
)
)
vs.
_______________________________
Respondent
No. ______________
AFFIDAVIT
Petitioner ______________________________, the Petitioner herein, being duly sworn, says as follows:
Q. What is your full name?
A.
Q. Where do you reside?
A.
Q. When and where were you married to the respondent? (date and place)
A.
Q. Are you still the spouse of the respondent? If not, give date and place of divorce.
January, 1986 (Revised)
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FORMS FOR ESTABLISHING AND MODIFYING SUPPORT ORDERS
CHAPTER 1240-2-1
(Rule 1240-2-1-.02, continued)
A.
Q. Were there any children born of this marriage?
A.
Q. What are their names, ages, and dates of birth?
A.
Q. Are the children living with you?
A.
Q. When did the respondent last live with you?
A.
Q. When and how much was his last contribution for support?
A.
Q. Is there a complaint or an order for support in any Court? If so, name the court, amount and docket number.
A.
Q. Are you employed? If so, what are your earnings?
A.
Q. Do you have any outstanding debts? (itemize balance due on charge accounts, etc.)
A.
Q. How much is spent each month for the support of yourself and/or the children?
A.
EXPENSES
Rent or Mortgage payment............................................................................................................ $ __________
Groceries and household supplies.....................................................................................................__________
Entertainment ..................................................................................................................................__________
Transportation .................................................................................................................................__________
(includes car payment, insurance payment,
gas, maintenance, or bus or car fare).
Medical............................................................................................................................................__________
(includes doctor bills, hospital bills,
insurance premiums, etc.)
Utilities............................................................................................................................................__________
(includes phone bill, electric bill,
natural gas bill, water and sewer,
garbage pickup bills).
Child Care .......................................................................................................................................__________
(includes baby sitting care, day care,
nursery, kindergarten).
School..............................................................................................................................................__________
(includes school supplies, school lunches,
etc., and tuition when applicable).
Insurance
(other than medical or automobile). .......................................................................................__________
Charge account payments.................................................................................................................__________
Loan payments.................................................................................................................................__________
Incidentals .......................................................................................................................................__________
(includes gifts, donations, subscriptions,
hair cuts, etc.).
Laundry and cleaning expenses........................................................................................................__________
Other (specify) .................................................................................................................................__________
TOTAL....................................................................................................................................... $ ___________
Q. Where is the respondent now living?
January, 1986 (Revised)
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FORMS FOR ESTABLISHING AND MODIFYING SUPPORT ORDERS
CHAPTER 1240-2-1
(Rule 1240-2-1-.02, continued)
A.
Q. Describe the respondent:
A. Height: __________ Weight: ___________ Date of Birth: _________________
Hair: ______________ Race: ____________________ Social Security No.:_________________
Photograph attached:________________ Eyes:_________________ Other: ______________________________.
Q. What is the respondent's usual occupation?
A.
Q. Where is the respondent employed and what is his/her salary?
A.
Q. To your knowledge, does the respondent have additional income? (second job, Military reservist, etc.)
A.
Q. Does the respondent own any property? If so, describe it.
A.
Q. Does the respondent have children under the age of 18 other than those listed on this form?
A.
Q. Is the respondent under a court order of support for any other children?
A.
Q. Was the respondent previously married?
A.
Q. If so, did he have children by this previous marriage?
A.
Q. If so, are any of these children under the age of 18?
A.
Q. Has the respondent subsequently married?
A.
Q. If so, does he have any children under the age of 18 by this subsequent marriage?
A.
Q. Are you receiving financial assistance from the Department of Human Services? If so, in what amount?
A.
Q. If you do not receive support from the respondent, will it become necessary for you to apply to the Department
of Human Services for financial assistance?
A.
Q. How much do you need from the respondent to support yourself and/or the children?
A.
__________________________________
PETITIONER
)
)
)
STATE OF _________________
COUNTY OF _______________________
Sworn before me this ________ day of ______________, 19/20 _____.
__________________________________
NOTARY PUBLIC OR CLERK
My commission expires:____________________________
Authority: PC 477 Acts of 1985, TCA §36-5-406. Administrative History: New rule filed December 17, 1985;
effective January 14, 1986
January, 1986 (Revised)
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1240-2-1-.03 NOTICE OF HEARING FORM. The following form, or another form containing all of the
information herein, may be used to notify respondent that a Petition to establish or modify a support order has been
filed against him/her, pursuant to TCA §36-5-401 et seq., and to notify the respondent of the time and date of the
hearing thereon:
IN THE _________________ COURT OF ____________________ COUNTY, TENNESSEE
_______________________________
Petitioner
)
)
)
)
)
)
vs.
_______________________________
Respondent
No. ______________
NOTICE
TO THE RESPONDENT, ______________________________________________________________________,
Notice is hereby given to you, _________________________________________ that the petitioner will appear
before the Honorable ______________________, Referee of the _______________ Court for
__________________ County, Tennessee, on the ________ day of _______________ , 19/20 ____, requesting the
Court: (check appropriate section)
____ (a) to order support and payments for the individuals listed in the attached Petition for Child Support.
____ (b) to enforce the order of support entered in the ________________ Court on the _____ day of
_______________, 19/20 ____, as set out in the attached Petition for Child Support.
____ (c) to modify the prior support order entered in the ______________ Court on the ______ day of
_______________, 19/20 ____, as set out in the attached Petition for Child Support.
The hearing is to be held at _____________.m. and you may be represented by a lawyer if you choose. This
hearing will be held at the following place: _______________________________________________________
IF YOU WANT TO TELL YOUR SIDE TO THE REFEREE, YOU MUST BE AT THE HEARING ON
____________ ______, 19/20_____. IF YOU DO NOT COME TO THE HEARING, THE REFEREE WILL
DECIDE BASED ONLY ON THE PETITIONER'S TESTIMONY AND MAY ISSUE AN ORDER: (check
appropriate section)
____ (a) REQUIRING THAT YOU PAY THE SUPPORT SOUGHT IN THE ATTACHED PETITION.
____ (b) ENFORCING THE SUPPORT BY PAYROLL DEDUCTION OR ANOTHER MEANS THAT
THE COURT FINDS REASONABLE.
____ (c) GRANTING THE MODIFICATION OF THE PREVIOUS SUPPORT ORDER WHICH IS
SOUGHT IN THE ATTACHED PETITION.
__________________________________
CLERK
January, 1986 (Revised)
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FORMS FOR ESTABLISHING AND MODIFYING SUPPORT ORDERS
CHAPTER 1240-2-1
(Rule 1240-2-1-.03, continued)
Certificate of Service
I certify that a copy of this Notice, Petition, and Testimony was given to the Petitioner and was served on
Respondent by mailing Notice, Petition, and Testimony by certified mail return receipt requested on the ______
day of ________________, 19/20____.
__________________________________
CLERK
Authority: PC 477, Acts of 1985; TCA §36-5-406. Administrative History: New rule filed December 17, 1985;
effective January 14, 1986.
January, 1986 (Revised)
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