SUPPLEMENTAL PETITION TO MODIFY PARENTAL RESPONSIBILITY, VISITATION, OR PARENTING PLAN/ TIME-SHARING SCHEDULE AND OTHER RELIEF
Name
First Name
Middle Name
Last Name
Social Security Number
Date of Birth
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County of Residence
Home Number
Please enter a valid phone number.
Format: (000) 000-0000.
Fax Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Spouse Information
Name
First Name
Middle Name
Last Name
Social Security Number
Date of Birth
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County of Residence
Home Number
Please enter a valid phone number.
Format: (000) 000-0000.
Fax Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
How did you hear about us?
Please Select
Social Media
Google
Retained Attorney
Friend
Other
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SUPPLEMENTAL PETITION TO MODIFY PARENTAL RESPONSIBILITY, VISITATION, OR PARENTING PLAN/ TIME-SHARING SCHEDULE AND OTHER RELIEF (Continued)
Financial Information
Your Income
Your Occupation
Employers Name
Employers Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Monthly Gross Income
Monthly Bonus, Commissions, etc.
Monthly Disability/SSI
Monthly Worker's Compensation
Monthly Unemployment
Monthly Pension/Retirement
Monthly Social Security
Monthly Alimony
Monthly Interest and Dividend
Monthly Rental Income
Royalties, Trust and Estates
Monthly Reimbursed Exspenses
Monthly Gains from Dealing in Property
Monthly "Other Income"
Your Deductions
Monthly State and Federal Withholdings
What is your filing status?
Please Select
Single
Married, filed separate
Married, filed joint
Head of Household
Number of Co-Dependents claimed
Monthly FICA and Self-employment Taxes
Monthly Medicare
Monthly Mandatory Union Dues
Monthly Mandatory Retirement Dues
Monthly Health & Dental Insurance
Monthly Court Ordered Child Support
Monthly Court Ordered Alimony
Your Monthly Expenses
Mortgage or Rent
Property Taxes
Utilities
Telephone (basic service)
Food (grocery)
Meals outside the home
Maintenance/Repairs
Auto Gas
Auto Repairs
Auto Insurance
Child Day Care
Child Lunch Money
Child Grooming (haircuts, etc.)
Child Clothing
Child Holiday Gifts
Child Medical/Dental (Uninsured)
Medical/Dental Insurance (Uninsured): Life insurance (not from job}
Your monthly clothing
Your monthly grooming
Your monthly entertainment
Your monthly Gifts
Religious Organizations
List Payments to Creditors
ASSETS AND LIABILITIES:
Cash in Banks and/or Credit Unions
Stocks, Bonds, Notes (value)
Real Estate (Home and/or Land value)
Automobile(s) Information
Retirement Plans(value)
Other personal property (furniture, etc)
Mortgage on Real Estate (Amount owed)
2nd Mortgage on Home (Amount owed)
Information Related to minor Child(ren), If any
Other Financials (Deductions, Expenses, Assets & Liabilities)
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SUPPLEMENTAL PETITION TO MODIFY PARENTAL RESPONSIBILITY, VISITATION, OR PARENTING PLAN/ TIME-SHARING SCHEDULE AND OTHER RELIEF (Continued)
Since the final judgment or last modification thereof, there has been a substantial, material and unanticipated change in circumstances, requiring a modification of the parental responsibility, visitation, or Parenting Plan/Time-Sharing schedule. Those changes are as follows: {explain}
I ask the Court to modify the parental responsibility, visitation,- Parenting Plan or Time-Sharing schedule as follows: {explain}
List the addresses, the year(s), county, and who the child(ren) resided with in the last 5 years.
Has there been any previous court action concerning the children?
Please Select
Yes
No
If yes, list the State and County and the Docket or Case Filing Number. State what happened in the litigation.
If you are seeking child support, State the Amount agreed upon
Does anyone currently have court ordered custody or visitation rights to the child(ren)? If yes, who will have primary Custody of the minor Child(ren)?
What days will the minor child(ren) be with whom and at what times will the sessions begin and end?
Who will have custody or visitation of what holidays?
Who will be responsible for providing the following insurance coverage for the minor child(ren)?H (Husband), W (Wife), or B (Both)
OTHER RELIEF REQUESTED
Submit
Should be Empty: