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Affidavit In Support Of Motion To Modify Child Support And Or Spousal Maintenance CSD-203 - Minnesota
| Affidavit In Support Of Motion To Modify Child Support And Or Spousal Maintenance Form. This is a Minnesota form and can be used in Child Support District Court Statewide . |
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State of Minnesota County In Re the Marriage of: District Court Judicial District: Court File Number: Case Type: Plaintiff / Petitioner vs / and Defendant / Respondent Intervenor STATE OF MINNESOTA ) COUNTY OF _____________________ ) SS (County where Affidavit Signed) Affidavit in Support of Motion to Modify Child Support and/or Spousal Maintenance My name is (check one) (Petitioner/Plaintiff) oath the following information: . I am the (Respondent/Defendant) in this case, and I state under Reasons Why the Existing Order Should Be Changed: 1. I request a change in the existing order because of (check all that apply): Substantially increased or decreased earnings of the party (check one) Obligee (receiving support/maintenance) Obligor (paying support/maintenance) Substantially increased or decreased needs of the (check at least one) child(ren) Obligee Obligor Receipt of public assistance by the (check one) Obligee Obligor A change in the cost-of-living for (check one) Oblgiee Obligor Extraordinary medical and/or dental expenses of the child(ren). A change in the availability of health or dental insurance coverage. A substantial increase or decrease in existing work-related or education-related child care expenses of the (check one) Obligee Obligor Receipt of social security benefits by the (check all that apply) Obligee Obligor child(ren) A change in the residence of the child(ren) Emancipation of a child (name of child): _________________________. 2. I make the following other comments in support of my request for a change to the CSD203 State ENG Rev-9/05-D www.courts.state.mn.us/forms Page 1 of 5 American LegalNet, Inc. www.FormsWorkflow.com existing support/maintenance order: Information From Existing Child Support Order: (Answer only those questions that apply) (Skip this question if motion is for spousal maintenance only) 3. I am the parent of the following children involved in this case (list only children involved in this case, and for each child check if you are the obligee or obligor): Child's Name Date of birth Obligee/Obligor ________________________________________________ Obligee Obligor ________________________________________________ Obligee Obligor ________________________________________________ Obligee Obligor ________________________________________________ Obligee Obligor ________________________________________________ Obligee Obligor 4. The existing support/maintenance order was issued by the court in ________________ County and is dated ________________________________. In that Order, I am the (check one) Obligor (making payments) Obligee (receiving payments) At the time the existing order was issued, I was (check one): Unemployed. Employed at (company or occupation) and per hour week month with a monthly net income of earned $ $ and had other monthly income totaling $_________________ (list all sources, such as from employment, public assistance, social security, or other source). At the time the existing order was issued, to the best of my knowledge, the other parent was (check one): Unemployed. (company or occupation) and Employed at per hour week month with a monthly net income of earned $ $ and had other monthly income totaling $_________________ from (list all sources, such as employment, public assistance, social security, or other source). 5. 6. At the time the existing order was issued, the child(ren) received monthly benefits in the from amount of $ (list all sources such as social security benefits) Current Information: 8. I am currently (check one) employed unemployed (if employed, answer the 7. CSD203 State ENG Rev-9/05-D www.courts.state.mn.us/forms Page 2 of 5 American LegalNet, Inc. www.FormsWorkflow.com following): a. Employer: b. Address: c. Work telephone number: d. Occupation: e. Length of employment: f. Supervisor: g. Gross Pay: $__________________ Net Pay: $ ____________________ h. Paid: Weekly Every other week Twice a month Monthly i. Number of withholding exemptions: __________________ j. Previously employed by for ___________ years prior to the above employment. k. Cost of monthly medical insurance for self: $ l. Cost of monthly medical insurance for dependents: $ m. Cost of monthly dental insurance for self: $ n. Cost of monthly dental insurance for dependents: $ o. If insurance coverage is in place, list the names of who the insurance covers: 9. To the best of my knowledge, the other parent is currently: (check one) employed unemployed (if employed, answer the following): a. Employer: b. Address: c. Work telephone number: d. Occupation: e. Length of employment: f. Supervisor: g. Gross Pay: $__________________ Net Pay: $ ____________________ h. Paid: Weekly Every other week Twice a month Monthly Unknown i. Number of withholding exemptions: __________________ j. Previously employed by for ___________ years prior to the above employment. k. Cost of monthly medical insurance for self: $ l. Cost of monthly medical insurance for dependents: $ m. Cost of monthly dental insurance for self: $ n. Cost of monthly dental insurance for dependents: $ o. If insurance coverage is in place, list the names of who the insurance covers: I have the following additional sources of income: (for example, public assistance, social security, Supplemental Security Income, pensions, Retirement and Survivors Disability Income, renters income, child support for other children): Source: _____________________________________________ $____________ month Source: _____________________________________________ $____________ month Source: _____________________________________________ $____________ month The value of the property I currently own by myself or with someone else is: Home $____________________ 10. 11. CSD203 State ENG Rev-9/05-D www.courts.state.mn.us/forms Page 3 of 5 American LegalNet, Inc. www.FormsWorkflow.com Household goods $____________________ Purchase price of my home $_________________ Balanced owed on my home $____________________ Other real estate $____________________ Checking/savings $____________________ Automobiles $____________________ (year and make) Recreational vehicles $____________________ (year and make) Personal property $____________________ Stocks/bonds/etc. $____________________ 12. I am currently (check all that apply): Married Separated Divorced Living with a companion Single If married or living with a companion: a. Present spouse's name or companion's name: b. Present spouse's or companion's net monthly income: $__________
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