Superior Court of Washington County of In re: No. Petitioner, and Petition for Modification of Child Support (PTMD) Respondent. I. Basis ___________________________________________ [Name] represents to the court that: 1.1 Place of Residence The petitioner resides in ____________________________________________ [County and State]. The child(ren) reside(s) in __________________________________________ [County and State]. The respondent resides in ___________________________________________ [County and State]. 1.2 Jurisdiction Over Parents This court has jurisdiction over the parents for the reasons that follow. [] [] [] 1.3 There is a Washington Order of Child Support. Both parties presently reside in the state of Washington. Other: Most Recent Support Order The most recent support order was entered in __________________________ [County and State] on ___________________________________ [Date]. Pet for Mod of Child Suppt (PTMD) - Page 1 of 4 WPF DR 06.0100 (6/2006) - RCW 26.09.170; .175 American LegalNet, Inc. www.USCourtForms.com The order requires ___________________________________ [Name] to pay $________ per month for the support of (list name(s) of the child(ren): 1.4 Reasons for Modifying Child Support The order of child support should be modified for the following reasons. [] [] [] [] [] [] The previous order was entered more than two years ago and there has been a change in the income of the parents. ___________________________________ [Name of child] is in need of post secondary educational support because the child is in fact dependent and is relying upon the parents for the reasonable necessities of life. ___________________________________ [Name of child] is a dependent adult child and support should be extended beyond his or her 18th birthday. The previous order was entered by default. The action was commenced by DSHS for a child who is receiving public assistance money and modification pursuant to RCW 26.09.170(8) is appropriate. The previous order was entered more than a year ago and: [] [] [] [] [] The order works a severe economic hardship. The child has moved to a new age category for support purposes. The child is still in high school and there is a need to extend support beyond the child’s 18th birthday to allow the child to complete high school. An automatic adjustment of support should be added consistent with RCW 26.09.100. Either or both parents should be required to maintain or provide health insurance coverage consistent with RCW 26.09.105. [] [] 1.5 There has been the following substantial change of circumstances since the order was entered (explain): Other: Starting Date of Modified Order Pet for Mod of Child Suppt (PTMD) - Page 2 of 4 WPF DR 06.0100 (6/2006) - RCW 26.09.170; .175 American LegalNet, Inc. www.USCourtForms.com [] [] 1.6 Does not apply. The starting date of the modified child support order should be the date on which this petition is filed. Other II. Relief Requested The court should modify the order of child support by requiring either or both parents to maintain or provide health insurance coverage consistent with RCW 26.09.105 for the child(ren), if not previously ordered, and by: [] [] [] [] [] [] [] ordering child support payments which are based upon the Washington State Child Support Schedule. A copy of the child support worksheet is filed with this action. ordering repayment or credit for overpaid child support since the date of filing this petition. ordering payment of underpaid child support since the date of filing this petition or entering judgment in that amount. requiring a periodic adjustment of support. extending child support beyond ___________________________________’s [Name of child] 18th birthday to allow the child to complete high school. extending child support beyond ___________________________________’s [Name of child] 18th birthday until (he) (she) is no longer dependent upon either or both parents and is capable of selfsupport. allowing for post secondary educational support for _______________________ [Name of child]. ordering the payment of day care. ordering the payment of educational expenses. ordering the payment of long distance transportation expenses. ordering the payment of uncovered health care expenses. awarding the tax exemption for the children as follows: [] [] ordering the payment of attorney fees and costs. other: [] [] [] [] [] Dated: Signature of Petitioner or Lawyer/WSBA No. Print or Type Name Pet for Mod of Child Suppt (PTMD) - Page 3 of 4 WPF DR 06.0100 (6/2006) - RCW 26.09.170; .175 American LegalNet, Inc. www.USCourtForms.com I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed at ___________________________ [City] ______________ [State] on ____________________ [Date]. Signature of Petitioner Print or Type Name Pet for Mod of Child Suppt (PTMD) - Page 4 of 4 WPF DR 06.0100 (6/2006) - RCW 26.09.170; .175 American LegalNet, Inc. www.USCourtForms.com