REQUEST TO MODIFY CHILD SUPPORT - PINAL COUNTY - (SIMPLIFIED PROCEDURES)

 
 
REQUEST TO MODIFY CHILD SUPPORT - PINAL COUNTY - (SIMPLIFIED PROCEDURES)
Revised 09.29.15

    REQUEST TO
MODIFY CHILD SUPPORT
      (SIMPLIFIED PROCEDURES)

              PINAL COUNTY
To Change Only the Current Monthly Child Support Amount

            INSTRUCTIONS AND FORMS

            Provided as a Public Service by
                 AMANDA STANFORD
              Clerk of the Superior Court
INSTRUCTIONS
                        How to complete Request to Modify Child Support
                                   (Simplified Procedures)

COMPLETE THIS FORM IF:
   You have an Arizona child support order and believe the amount of support should be
     changed, AND
   You have completed a “Parent's Worksheet for Child Support Amount” and it results in a
     child support amount (item 38) that varies 15% or more from the amount of your current
     order.

TO COMPLETE THIS FORM YOU WILL NEED:
    A copy of your current Arizona Child Support Order
    A completed Parent's Worksheet for Child Support Amount

NOTE: Generally you should file this Request for Modification in the County where the order you
are seeking to modify was filed.

NOTE: There will be a charge for filing this request. There may be other charges including an
appearance fee if this is your first appearance in this case. If you are unable to pay these
amounts, they can be waived or deferred. The Clerk of the Superior Court has the necessary
forms to ask for a waiver or deferral.

WHEN YOU HAVE COMPLETED THIS FORM:
File the following forms with the Clerk of the Superior Court:
         1. Request to Modify Child Support
         2. A Completed Parent's Worksheet for Child Support Amount
         3. A proposed Child Support Order.
         4. An Income Withholding Order completed according to the directions for that form.

   Follow these instructions which are numbered to match the identifying numbers on the
                      form. Please type or print neatly using black ink.

(1)      Enter the name, address, and phone number of the person filing the form. Indicate if the
         petitioner or the respondent is the person filing, and whether or not the person is self-
         represented or represented by an attorney.

(2)      Enter the name of the county where you are filing this Request to Modify.

(3)      Enter the name of the person shown as the petitioner on your order for child support.

(4)      Enter the name of the person shown as the respondent on your order for child support.

(5)      Enter the case number that appears on your Arizona Child Support Order.

(6)      Select petitioner or respondent to identify the party requesting the modification.

(7)      Enter the date on which the judge or commissioner signed your current child support
         order.

(8)      Enter the name of the judge or commissioner who signed your current child support
         order.

(9)      Check the appropriate boxes indicating whether Mother, Father, or neither party has

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been ordered to provide medical, dental, and vision care insurance.

(10)     Check whether Mother or Father has been ordered to make child support payments.

(11)     Fill in the amount and payment due date of your current child support order as it was
         ordered by the court. (EXAMPLE: $150 per month payable on the 1st day of the month or
         $150 per month payable one-half on the first and one-half on the 15th of the month).

(12)     Fill in the amount calculated from the completed Parent's Worksheet for Child Support
         Amount.

(13)     Calculate the percentage of change between your current support amount and the
         amount calculated pursuant to the Parent's Worksheet for Child Support Amount. To
         determine the percentage, subtract the larger amount from the smaller amount. Divide
         that number by the current support amount.
             a. Fill in the difference between the amount of child support ordered and the
                 amount requested to be ordered.
             b. Fill in the amount of the child support currently ordered.
             c. the percentage change calculated by dividing the amount for "a" by the amount
                 for "b".
             EXAMPLE: The current child support order is $225. The Parent’s Worksheet
             calculation result is $270. $270 - $225 = 45 ÷ $225 = 20%.

(14)     If the box for item (14) is marked "yes" indicating that one of the parties is using the child
         support enforcement services of the Division of Child Support Enforcement (DCSE),
         notice of this action must be given to that DCSE office. You may drop it off or mail it to
         your local office. Find a child support office location nearest to you at:
         FindOfficeFormazdes.gov. If you live in Maricopa County, mail a copy of the "Request to
         Modify Child Support" and a copy of the "Parent's Worksheet for Child Support Amount"
         to:

                                  DES Division of Child Support Services
                                  ATTN: Modification
                                  P.O. Box 40458
                                  Phoenix, AZ 85067

         Serve the following items on the other party:
             A copy of your completed "Request to Modify Child Support," and
             A copy of your completed “Parent's Worksheet for Child Support Amount."

         Some counties also REQUIRE that you serve these items:
             A blank copy of the Request for Hearing and Notice of Hearing form with
               instructions, and
             A blank copy of the Parent's Worksheet for Child Support Amount with
               instructions.

         To "serve” means to use the legally required method of delivering notice or documents,
         pursuant to Rules 40, 41, and 42, of the Arizona Rules of Family Law Procedure. The
         most common method of service on a party is personal service by a private process
         server or sheriff. Process servers are listed in the yellow pages and on the internet.

         When service has been completed, file proof of service with the Clerk of Superior Court.
         The Affidavit of Service is usually prepared by the person serving the document,
         indicating the date and time service was made.

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(15)     If there are other court-ordered payments included in the current Income Withholding
         Order, enter the date the Income Withholding Order was signed, and the amounts and
         frequency of payments ordered.

(16)     Enter the amount of child support being requested that was calculated in the Parent’s
         Worksheet.

(17)     Check the appropriate boxes indicating responsibility for providing medical, dental, and
         vision care insurance.

(18)     Enter the amount each parent will contribute for medical/dental/vision care expenses not
         paid by insurance. Indicate as a percentage.

(19)     The party filing the request for a change in child support order must date and sign this
         document. By signing, you are stating under oath, or affirming, that the contents of this
         request are true and correct under penalty of perjury.

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PROCEDURES
  What to Do After You Have Completed Request to Modify Child Support Forms

STEP 1:          MAKE TWO COPIES* (or 3, if the State DES/ Dept of Child Support Enforcement is
                 involved) of the:

                      Request to Modify Child Support and Parent’s Worksheet

STEP 2:          Separate your papers into three sets* (4, if DES or Dept of Child Support Enforcement is
                 involved)

Set 1 – ORIGINALS for the Clerk of Superior Court:        Set 2 – COPY for the Other Party
   (1)   Original Request to Modify Child Support              (1) Request to Modify Child Support
   (2)   Original Parent’s Worksheet                           (2) Parent’s Worksheet
   (3)   Child Support Order                                   (3) Instructions and forms for Request for
   (4)   Income Withholding Order/Notice for Support               Hearing and Notice of Hearing
   (5)   Employer Information Sheet
                         AND
   (1) 2 Self Addressed, Stamped envelopes:
   (2) One addressed to you;
   (3) One addressed to the Other Party

Set 3 – COPY for You                                      Set 4 – COPY for State (*if required)
   (1) Request to Modify Child Support                         (1) Request to Modify Child Support
   (2) Parent’s Worksheet”                                     (2) Parent’s Worksheet
                                                               (3) Acceptance of Service

STEP 3:          FILE THE PAPERS WITH THE CLERK OF THE COURT. We have three office locations
                 where you can file your papers:

                      Pinal County Justice Complex                Apache Junction Office
                     971 N. Jason Lopez Circle Bldg. A           575 N. Idaho Rd. Suite 109
                            Florence AZ 85132                    Apache Junction, AZ 85119
                              (520) 866-5300                          (520) 866-5300
                            Fax (520) 866-5320                      Fax (520) 866-6170

                           Casa Grande Office                         Mammoth Office
                      820 E. Cottonwood Lane Bldg. B                (Temporarily Closed)
                          Casa Grande, AZ 85122
                              (520) 866-5300
                            Fax (520) 866-7481

                 FILING FEE: There is a fee for filing this Petition and there may be other charges
                 associated with this process. Inquire with the Clerk’s office regarding the filing fee
                 amount. The fee is payable to the Clerk of the Superior Court by money order, personal
                 check with proper identification, Cash, Visa, MasterCard, debit or credit.

                 Go online to http://www.coscpinalcountyaz.gov/fees.html for current filing fees.
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If you cannot pay these fees, you may request the fee(s) be deferred or waived. The
              Clerk of the Superior Court has the necessary forms to ask for a deferral or waiver. With
              the Application for Deferral, you must provide proof of income (copy of your last 2 most
              recently paystubs).

              Hand the originals and all set of copies to the clerk at the filing counter and along with
              your method of payment. The Clerk will keep the original, stamp the extra copies to show
              that the original document was filed with the Court. The clerk will return the stamped
              copies to you. The stamped copies are called “conformed” copies.

STEP 4:       MAKE SURE YOU GET BACK FROM THE DEPUTY CLERK THE FOLLOWING:
               Your conform copy
               The other party’s stamped copy
               The copy for DES / Dept of Child Support Services (if required)

STEP 5:       SERVE THE PAPERS ON THE OTHER PARTY(IES). The copy of the Request to
              Modify and Parent’s Worksheet may be delivered by the Sheriff’s Office, a licensed
              process server, commercial delivery service or mail by which you can obtain an original
              or copy of the other party’s signature confirming delivery, or by an notarized Acceptance
              of Service, signed by the other party(ies). Whatever method you choose, the original
              proof of service must be filed with the Clerk of the Court.

              Serves on the State of Arizona: If the Attorney General’s Child Support Services
              Section has been involved with your case, you MUST also serve the Attorney General’s
              office. The Attorney General’s office will ACCEPT service. You must deliver an
              Acceptance of Service form to the Child Support Services Section of the Attorney
              General’s office:

              Attorney General’s Office
              Child Support Services Section
              PO Box 608
              Florence Arizona 85132
              Site Code: 039-A

              After the Attorney General’s office signs the Acceptance of Service, you MUST file the
              original signed Acceptance of Service with the Clerk of the Court.

STEP 6:       WAIT. If the other party is served in the State of Arizona, the person has 20 days from
              the date of service to file a Request for Hearing. If the party is served outside of Arizona
              has 30 days from the date of service to file a Request for Hearing.

              If a Request for Hearing is filed and a hearing is set, you will receive written notice of the
              date, time and location to appear for Court. OR

              After the time has lapsed and no party requests a hearing, the Judge may grant your
              request and sign the Income Withholding Order/Notice for Support. OR

              The Judge may schedule a hearing to obtain further information and all parties will
              receive written notice of the date, time and location to appear for Court.

For more information review the Rules of Family Law Procedures.

Forms can be found at: http://www.coscpinalcountyaz.gov/forms.html

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PARENT’S WORKSHEET FOR CHILD SUPPORT AMOUNT
Prepared By (1):      Petitioner     Respondent       Judiciary      Court Staff     IV-D Agency
Name of person filing: (2)                                  Date prepared (3)
Petitioner (4)                                              Case No. (6)
Respondent (5)                                              ATLAS No. (7)
Time-sharing arrangement (8):         Essentially equal      Mostly with Father        Mostly with Mother

 (9) Child(ren)’s names (First, Middle Initial, and last name          Date of birth (mo/day/year)          Age

Presumptive termination date                 Actual termination date                Youngest grade                   .
Number of minor children                Number of children age 12 or over                .
                                                                                Father                    Mother
Gross Monthly Income (10)                                                   $                        $                    .
  Spousal maintenance paid (11)                                             $-                       $-                   .
  Spousal maintenance received (12)                                         $+                       $+                   .
  Custodial parent of other children subject of court order(s) (13)
                                                 Father     Mother          $-                       $-                   .
  Court-ordered child support paid for children of other relationships (14) $-                       $-                   .
  Other natural or adopted children not subject of court order(s) (15)
                                                 Father     Mother          $-                       $-                   .
                                               Standard deduction           $-                       $-                   .
      Alternate Deduction (only of less than standard deduction)            $-                       $-                   .
Adjusted Gross Monthly Income (16)                                          $                        $                    .
Combined Adjusted Gross Income (17)                                             $                                .
Basic Child Support Obligation for        children (18)                         $                                .
Additions:
  Adjusted for        children over age 12 at        % (19)                     $                                .
  Medical, dental and vision insurance paid (20)                            $                        $                    .
  Monthly childcare costs (21) for        child(ren)                        $                        $                    .
        Less deferral tax credit allowed to custodian at        %           $                        $                    .
  Extra education expenses paid (22)                                        $                        $                    .
  Extraordinary (gifted or handicapped) child expenses paid (23)            $                        $                    .
  Subtotal (24)                                                             $                        $                    .
  Total Adjustments for Costs (25)                                             $                             .
Total Child Support Obligation (26)                                            $                             .
Each parent’s proportionate percentage of combined income (27)                           %                               %
Each parent’s proportionate share of the total support obligation (28)      $                        $                    .
Less paying parent’s costs (29)                                             $                        $                    .
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PARENT’S WORKSHEET FOR CHILD SUPPORT AMOUNT

Costs associated with parenting time (30): Table A        Table B
  No. of days
  Line (18) x     %                                                 $               $              .
Adjustments subtotal (31)                                           $               $              .
Preliminary Child Support Amount (32)                               $               $              .
Self-Support Reserve Test for Payor (33)
  Line (16) $     Less paid arrears $      Less $903                $               $              .
Child support amount to be paid by (34):    Father     Mother       $               $              .

Travel related to parenting time (35)                                   %                         %
Medical, dental, and vision costs not paid by insurance (36)            %                         %

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(1)
Name of Person Filing:
Person filing is the:             Petitioner    Respondent
Street Address:
City, State, Zip Code:
Telephone Number:
Email Address:
ATLAS Number (if applicable)
      Representing Self (No Attorney)      or    Represented by Attorney
If Attorney, Bar Number:

                      SUPERIOR COURT OF ARIZONA (2)                                         COUNTY
(3)                                                          (5) CASE NUMBER:     DO2
Name of Petitioner
                                                             REQUEST TO MODIFY CHILD SUPPORT
                                                             PURSUANT TO GUIDELINES SIMPLIFIED
                                                             PROCEDURES
(4)
Name of Respondent

               IMPORTANT NOTICE TO PARTY NOT REQUESTING THE MODIFICATION
                          Your support order may be modified if you do not request a hearing.

(6) The          Petitioner, or   Respondent asks this court to modify the Arizona child support order in this case
        entered on      (7)    /       /        by (8)
                         (month / day / year)                         (Name of judge or commissioner)

A. Under the current child support order (9):
      Mother is responsible for providing                         medical       dental     vision care insurance
      Father is responsible for providing                         medical       dental     vision care insurance
      Neither party was ordered to provide                        medical       dental     vision care insurance
B. The child support currently in effect requires (10)       Mother, or the   Father to make
       payments of (11)       $                           per month, payable on the                      day of the month.

C. Attached is a Parent’s Worksheet for Child Support Amount. According to the worksheet calculations the
       child support amount should be (12)         $                    per month.
D. The following calculations show that the requested change varies from the current-ordered child support
   amount by 15% or more.
       (13)     (a)                    divided by (b)                    equals (c)                             %
              a = the difference between the amount currently ordered and the amount requested
              b = the amount currently ordered; and
              c = the percentage change

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E. Is the Division of Child Support Enforcement (DCSE) providing child support enforcement services for at least
   one of the parties? (14)    Yes     No    Unknown (If “Yes” is selected, see instructions for providing notice
   to the State.)

F. Other court-ordered payments included in the current Income Withholding Order dated:
     (15)           /       /               (month/day/year)

     Current Spousal Maintenance:                                  $                per
     Payments on Child Support Arrearages/Interest:                $                per
     Payments on Spousal Maintenance Arrearages/Interest           $                per
     Other:                                                        $                per
     Clearinghouse Handling Fee                                    $ 5.00           per    month

RELIEF REQUESTED OF THIS COURT:
   1. I request that child support be ordered in the amount of (16) $____________ per month to be paid by the
          Mother or the     Father, and that relief requested in the Parent’s Worksheet be ordered.

     2. REGARDING INSURANCE FOR MINOR CHILDREN, order that (17):
           Mother is responsible for providing          medical     dental    vision care insurance
           Father is responsible for providing          medical     dental    vision care insurance
        The costs of medical/dental/vision care expenses not paid by insurance shall be shared as follows: (18)
        Mother __________% Father _________%. Request for payment or reimbursement must be provided to
        the obligated parent(s) within 180 days after the services occurred. The obligated parent must pay or
        make payment arrangements with 45 days after receipt of the request.

     3. If this matter goes to hearing, I further request that costs and fees incurred in bringing this action be
        ordered to be paid by the opposing party.

                                              OATH OR AFFIRMATION
                   I affirm the contents of this document are true and correct under penalty of perjury.

Date                                                                              Signature

State of Arizona                    )
                                    )
County of                           )

SUBSCRIBED AND SWORN TO before me this                         day of                                      ,   20
by
                   Name of Signer

Commission Expires                                                      Notary Public

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NOTICE TO PARTIES
If you do not agree with the modification, you have twenty days in which to ask for a hearing on the requested modification. If
service of process is made outside the State of Arizona, the parent receiving service has 30 days in which to ask for a hearing
on the requested modification.

Upon proof of service and if no hearing is requested within the time allowed, the court will review the request and enter an
appropriate order modifying the support award. If an error is noted the amount awarded may be different from the amount
requested, but there will be no greater modification then requested.

In the event the court has serious concerns regarding the accuracy of the information, or if a substantial mathematical error is
found, the court may set the matter for hearing. If either party requests a hearing within the time allowed, the court shall
conduct the hearing. No order shall be modified without a hearing if one is requested.

If you wish to request a hearing, you may obtain the flowing forms from the office of the Clerk of the Superior Court. These
forms may be in your packet.
                   ●        Request for Hearing and Notice of Hearing
                   ●        Parent’s Worksheet for Child Support Amount

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CHILD SUPPORT CALCULATOR for
                            Parent’s Worksheet to determine Child Support Amount

                                                        The Court Self Help website offers a Free Child Support
                                                        Calculator and Fillable Forms.

                                                       Simple          Quick             Accurate

                               If you have a personal computer with Internet access,
                                   you can access the Child Support Calculator at:

                                                 http://www.azcourts.gov/familylaw

                                You may also visit the Law Library at the
                  Pinal County Superior Court House for access and further assistance.

                                       Calculate Support for Parent’s Worksheet

Your computer must be connected to a printer. Begin by selecting which Child Support Calculator applies to you, 2005 or 2011, then
press the Tab button on your keyboard to move through the form, or click on each field with your mouse.

Enter the appropriate information in each blank field. Not every blank field needs to be completed in every case. If you are not sure
whether you should complete a blank field, click on the question mark (?) next to the blank field. You will receive additional information
in accordance with the Arizona Child Support Guidelines.

When you have completed the Entry Form, click the "Print Worksheet" button to receive an estimate of the amount of child support the
non-custodial parent may have to pay to the custodial parent for the support of their child(ren).

After clicking on "Print Worksheet" the form will automatically be filled in with the information from the Entry Form. Print the form and
bring it with you at the time of filing your initial paperwork.

The Court Self Help website also offers the following fillable forms required to set up Child Support, select the “Forms” tab to make
your selection:

        Child Support Order
        Post Paternity Establishment of Child Support Order
        Paternity Judgment Child Support Order

To have the Child Support amount automatically deducted from payroll, either of the below forms must be submitted:

        Income Withholding Order – May be completed by either party
        Current Employer Information – To be completed by the non-custodial parent/obligor/payer only

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(1) Name of Person Filing: _____________________________
Person filing is the:  Petitioner  Respondent
Mailing Address (if not protected): ______________________
City, State, Zip Code: _________________________________
Phone Number: ______________________________________
 Representing Self, Without an Attorney
(If Attorney) State Bar Number: _________________________
Attorney E-Mail Address: ______________________________                                  For Clerk Use Only

            SUPERIOR COURT OF ARIZONA COUNTY OF                       (2) _____________________

                                                        )   (5) Case No.
                                                        )   _______________________________
(3)___________________________________                  )
Petitioner                                              )
                                                        )
                                                        )
and                                                     )   (6) ATLAS No. _____________________
                                                        )
                                                        )
(4)___________________________________                  )
Respondent                                              )
______________________________________                  )            CHILD SUPPORT ORDER

THE COURT FINDS that:
    1. (7)_________________, Father and (8)________________ Mother, owe a duty to support the following
       child(ren):

                      Name                                                     Date of Birth
        (9) ________________________________                      ___________________________________
        ___________________________________                       ___________________________________
        ___________________________________                       ___________________________________
        ___________________________________                       ___________________________________
        ___________________________________                       ___________________________________
        ___________________________________                       ___________________________________

    2. Child Support Guidelines.
       The required financial factors and any discretionary adjustments pursuant to the Arizona Child Support
       Guidelines are as set forth in the Child Support Worksheet, attached and incorporated herein by
       reference.

    3. Child Support.
       (10a) [ ] Father [ ] Mother is obligated to pay child support to [ ] Father [ ] Mother in the amount of
       $________per month pursuant to the Arizona Child Support Guidelines without deviation.

        (10b) [ ] Father [ ] Mother is obligated to pay child support to [ ] Father [ ] Mother in the amount of
        $________per month pursuant to the Arizona Child Support Guidelines without deviation. This amount is
        an appropriate amount to award for child support in this case except that the Court finds it more

Arizona Supreme Court – Self Service Center
January 2013
Child Support Order
Case No._____________________

    appropriate and just to make a rounding adjustment to the exact guideline amount for ease of calculation
    to $___________ per month.

    (11a) [ ] Father [ ] Mother is obligated to pay child support to [ ] Father [ ] Mother in the amount of
    $_______ per month pursuant to the Arizona Child Support Guidelines. Application of the child support
    guidelines in this case is inappropriate or unjust. The Court has considered the best interests of the child
    in determining that a deviation is appropriate. After deviation the child support order is $_____________
    per month.

    (11b) [ ] Father [ ] Mother is obligated to pay child support to [ ] Father [ ] Mother in the amount of
    $_______ per month pursuant to the Arizona Child Support Guidelines. Application of the child support
    guidelines in this case is inappropriate or unjust. The Court has considered the best interests of the child
    in determining that a deviation is appropriate. After deviation the child support order is $_____________
    per month. Further, the parties have entered into a written agreement or their agreement is on the record
    and is free of duress and coercion with knowledge of the amount of child support that would have been
    ordered under the guidelines but for the agreement.

    Fill in the reason(s) for deviation below if (11a) or (11b) was selected.
    ____________________________________________________________________________________
    ____________________________________________________________________________________
    ____________________________________________________________________________________

4. Support Arrears.
   (12a) [ ] Father [ ] Mother owes child support arrearages to [ ] Father [ ] Mother in the total amount of
   $_____________for the time period of ____________ through __________ plus accrued interest on prior
   child support arrearages due of $____________ calculated thru the date of ____________.

    (12b) [ ] The court finds no child support arrearages due and owing.

    (12c) [ ] No evidence was presented in support of child support arrearages.

5. Past Support.
   (13a) [ ] It is appropriate to award [ ] Father [ ] Mother an additional judgment for past support in the
   amount of $____________ for the period between the filing of this current petition and the date current
   child support is ordered to begin.

    (13b) [ ] It is appropriate to award [ ] Father [ ] Mother an additional judgment in the amount of
    $____________ for past support owed from the date of separation, but not more than three years before
    the date of filing the current petition.

    (13c) [ ] The court finds no past support amount due and owing.

    (13d) [ ] No evidence was presented in support of past child support.

IT IS ORDERED that:

A. Child Support.
    (14) [ ] Father [ ] Mother shall pay child support to [ ] Father [ ] Mother in the sum of
    $_________________ per month payable by wage assignment on the first day of each month
    commencing ______________.

B. Support Arrearages Judgment.
   (15a) [ ] Father [ ] Mother is granted judgment against [ ] Father [ ] Mother in the sum of
   $______________ as and for child support arrearages for the period of _________________ thru the
   date of __________________ together with interest on said sum at the legal rate of 10% per annum until
   paid in full plus additional accrued interest on prior child support judgments of $________ calculated thru

                                                                                                   Page 2 of 5
Case No._____________________

    the date of _________ . [ ] Father [ ] Mother shall pay, in addition to his ___ her ___ current support
    payment, the sum of $_____________per month toward this judgment, payable on the first day of each
    month commencing __________________ until paid in full.

    (15b) [ ] No judgment for child support arrearages is entered.

C. Past Support Judgment.
   (16a) [ ] Father [ ] Mother is granted a past support judgment against [ ] Father [ ] Mother in the
   additional amount of $___________. [ ] Father [ ] Mother shall pay the additional amount of
   $____________ per month toward this judgment, payable on the first day of each month commencing
   _________________ until paid in full.

    (16b) [ ] No judgment for past support is entered.

D. Payments and Clearinghouse.
   All payments, plus the statutory handling fee, shall be made through the Support Payment Clearinghouse
   pursuant to an Order of Assignment or Income Withholding Order signed this date. Any time the full
   amount of support ordered is not withheld, the obligor remains responsible for the full monthly amount
   ordered. Payments not made directly through the Support Payment Clearinghouse shall be considered
   gifts unless otherwise ordered. All payments shall be made payable to and mailed directly to:

                                       Support Payment Clearinghouse
                                               PO Box 52107
                                          Phoenix, AZ 85072-2107

    (17) Payments must include the [ ] Father’s [ ] Mother’s name and ATLAS number. Pursuant to A.R.S.
    §25-322, the parties shall submit current address information in writing to the Clerk of the Superior Court
    and the Support Payment Clearinghouse immediately. The obligor shall submit the names and
    addresses of their employers or other payors within 10 days. The parties shall submit address changes
    within 10 days of the change.

E. Total Monthly Payments.
   (18) [ ] Father [ ] Mother shall make total monthly payments to [ ] Father [ ] Mother of $______ per
   month payable on the first day of each month commencing ______________ as follows:

      Monthly Payments:    Current child support payment as ordered above:         $ ___________

                           Child support arrearage payments:                       $ ___________

                           Current spousal maintenance payment:                    $ ___________

                           Past due spousal maintenance payment:                   $ ___________

                           Clearinghouse handling fee:                             $          5.00

                                                    Total monthly payment:         $ ___________

F. Non-Covered Medical Expenses.
   (19) [ ] Father [ ] Mother is ordered to pay____________% and [ ] Father [ ] Mother is ordered to
   pay_________% of all reasonable uncovered and/or uninsured medical, dental, vision, prescription and
   other health care charges for the minor child(ren). A request for payment or reimbursement of uninsured
   medical, dental and/or vision costs must be provided to the other parent within 180 days after the date the
   services occur. The parent responsible for payment or reimbursement must pay their share, as ordered
   by the court, or make acceptable payment arrangements with the provider or person entitled to
   reimbursement within 45 days after receipt of the request.

                                                                                                  Page 3 of 5
Case No._____________________

G. Medical, Dental, and Vision Insurance (A.R.S. § 25-320(J)).
   (20a) [ ] Father [ ] Mother shall be individually responsible for providing medical insurance for the minor
   child(ren) and shall continue to pay premiums for any medical, dental and vision policies covering the
   child(ren) that are currently included in the incorporated guidelines worksheet.

     (20b) [ ] Father [ ] Mother shall be individually responsible for providing medical insurance for the
     minor child(ren) of the parties as soon as it becomes accessible and available at a reasonable cost, as
     neither parent currently has the ability to obtain such medical insurance.

     Medical, dental, and vision insurance, payments and expenses are based on the information in the
     Parent’s Worksheet for Child Support Amount attached hereto and incorporated by reference. The parent
     ordered to pay must keep the other party informed of the insurance company name, address and
     telephone number, and must give the other party the documents necessary to submit insurance claims.
     An insurance card must be provided to the other parent. Notification must also be provided to the other
     parent if coverage is no longer being provided for the child(ren).

H. Travel Expenses.
   (21) The costs of travel related to parenting time over 100 miles away shall be shared as follows:

             Father_____________________%                              Mother_____________________%

I.   (22) Other Findings and Orders.
     ____________________________________________________________________________________
     ____________________________________________________________________________________
     ____________________________________________________________________________________
     ____________________________________________________________________________________

J.   Information Exchange.
     The parties shall exchange financial information such as copies of tax returns, financial affidavits, and
     earnings statements every twenty-four months. At the time the parties exchange financial information,
     they shall also exchange residential addresses and the names and addresses of their employers unless
     the court has ordered otherwise.

K. (23)Tax Exemptions.
   The Court allocates tax exemptions for the dependent children as follows:

              Child’s Name                  Date of Birth           Parent Entitled to Deduction for Each
                                                                                Calendar Year

     For any years following those listed above while the Child Support Order remains in effect, the parties
     shall repeat the above pattern of claiming deductions for each child.

     (23a) [ ] Father [ ] Mother may claim the allocated tax exemptions only if all child support and arrears
     ordered for the year have been paid by December 31 of that year.

     (23b) [ ] Father [ ] Mother may unconditionally claim the tax exemptions allocated to [ ] him [ ] her for
     income tax purposes.

                                                                                                    Page 4 of 5
Case No._____________________

L. Modification.
   If this is a modification of child support, all other prior orders of this Court not modified remain in full force
   and effect.

M. Emancipation.
   Although the obligation to pay support may continue, a child is emancipated:

            On the child’s 18th birthday. (However if a child is still attending high school or a certified high
             school equivalency program, support will continue but only until the child graduates or reaches 19
             years of age.)
            On the date of the child’s marriage.
            When the child is adopted.
            When the child dies.

    ________________________________________                     ______________________________________
    Date                                                         Judicial Officer

                                                                 ______________________________________
                                                                 Printed Name of Judicial Officer

    STIPULATION

    (24) SIGNATURE BY PETITIONER AND RESPONDENT:
    By signing this document, we state to the Court, under penalty of perjury, that we have read and agree to
    this Order and that all the information contained in it is true, correct and complete to the best of our
    knowledge and belief.

    ________________________________________                     _______________________________________
    Obligor                   Date                               Obligee                   Date

    ________________________________________                     _____________________________________
    Attorney for Obligor      Date                               Attorney for Obligee      Date

                                                                                                        Page 5 of 5
INSTRUCTIONS AND FORM
                         Request for Hearing and Notice of Hearing
                                        (Simplified Modification)

COMPLETE THIS FORM IF:

A Request to Modify Child Support Pursuant to Guidelines’ Simplified Procedure has been filed, AND

You want to have a hearing to explain your position.

TO REQUEST A HEARING YOU WILL NEED:

A copy of the Request to Modify Child Support, AND
A completed “Parent’s Worksheet for Child Support Amount.”

NOTE: There may be a charge for filing this Request. There may be other charges including an
appearances fee if this is your first appearance in this case. If you cannot pay these fees, you may
request the fees be deferred or waived. The Clerk of the Superior Court has the necessary forms to ask
for a deferral or waiver.

FOLLOW THESE INSTRUCTIONS NUMBERED TO MATCH THE IDENTIFYING NUMBERS ON THE
FORM. TYPE OR PRINT NEATLY USING BLACK INK.

(1) Fill in the name, address, and phone number of the person filing the form. (The spaces marked
    representing and state bar number is used only if an attorney is preparing this form).

(2) Fill in the name of the county that appears in this space on the Request to Modify Child Support.
          (This may already be printed on the form).

(3) Fill in the name of the person shown as the petitioner on the Request to Modify Child Support.

(4) Fill in the name of the person shown as the respondent on the Request to Modify Child Support.

(5) Fill in the case number that appears on the Request to Modify Child Support.

(6) Date and sign here before a Notary Public or a Deputy Clerk of the Court. By signing, you are stating
    under oath that the contents of this Request for Hearing are true and correct to the best of your
    knowledge.

(7) Leave this area blank; it will be completely by personnel at the Office of the Clerk of the Superior
    Court when you file these documents.

(8) List the name and current mailing address of the other party to this action. If you are using the child
    support services of the Department of Economic Security (DES) or if the other party answered YES to
    item 13 on the Request to Modify Child Support, you MUST also mail a copy of this Request for
    Hearing and Notice of Hearing to the Department of Economic Security.

(9) Sign and date the form to indicate that you will mail the Request for Hearing and Notice of Hearing as
    indicated.

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WHEN YOU HAVE COMPLETED THIS FORM GO TO THE OFFICE OF THE CLERK OF THE
SUPERIOR COURT TO FILE YOUR PAPERS:

You should arrive at the Clerk’s Office at least two hours before it closes. You may file your court papers
at the following locations:

                     Pinal County Justice Complex                Apache Junction Office
                    971 N. Jason Lopez Circle Bldg. A           575 N. Idaho Rd. Suite 109
                           Florence AZ 85132                    Apache Junction, AZ 85119
                             (520) 866-5300                          (520) 866-5300
                           Fax (520) 866-5320                      Fax (520) 866-6170

                          Casa Grande Office                         Mammoth Office
                     820 E. Cottonwood Lane Bldg. B                (Temporarily Closed)
                         Casa Grande, AZ 85122
                             (520) 866-5300
                           Fax (520) 866-7481

Give the form and your completed Parent’s Worksheet to the Clerk of the Superior Court. The Clerk’s
office will fill in the date, time and place of the Hearing and have the notice signed.

PAPERS:         Hand all three (3) sets of your court papers to the deputy clerk along with the filing fee.
                The clerk will file stamp and retain the originals and conform stamp your copies.

MAKE SURE YOU PROVIDE (2) STAMPED ENVELOPES IN ORDER TO RECEIVE THE FOLLOWING
FROM THE CLERK:
       Your set of Copies – Conformed Stamped
       Your Spouse’s Set of Copies – Conformed Stamped

IMMEDIATELY AFTER THE COURT SETS THE HEARING & FILLS IN THE INFORMATION IN
NUMBER 7:

You must mail a copy of the Request for Hearing and Notice of Hearing as indicated in item 8.

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(1)
Name of Person Filing:
Street Address:
City, State, Zip Code:
Telephone Number:
Email Address:
ATLAS Number (if applicable)
      Representing Self (No Attorney)   or   Represented by Attorney
If Attorney, Bar Number:

                                        SUPERIOR COURT OF ARIZONA
                                             (2)PINAL COUNTY

(3)                                                     (5) CASE NUMBER:        DO2
Name of Petitioner
                                                        REQUEST FOR HEARING AND
                                                        NOTICE OF HEARING
                                                        (Simplified Procedure)
(4)
Name of Respondent                                      HONORABLE:

A Request to Modify Child Support Pursuant to Guidelines’ Simplified Procedures, has been filed.

The information provided in the Parent’s Worksheet that was the basis for the Request to Modify Child Support is
not accurate. I am attaching the required completed Parent’s Worksheet that shows what I believe to be accurate
information. I request that a hearing be set so that I can explain to the judge or commissioner my position. I
further request that costs and fees incurred in responding to the Request for Modification be ordered to be paid by
the opposing party.

I Have Read This Document And The Information Given Here Is True And Correct To The Best Of My Knowledge.

Date                                                                             Signature

State of Arizona                    )
                                    )
County of                           )

SUBSCRIBED AND SWORN TO before me this                      day of                                     ,   20
by
                   Name of Signer

Commission Expires                                                     Notary Public

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NOTICE OF HEARING

The above verified Request for Hearing having been filed, this matter shall be heard:

(7) DATE AND TIME:

                                                      at                                a.m. / p.m.
                          (Date)                                     (Time)

PLACE:            PINAL COUNTY SUPERIOR COURT
                  971 N. JASON LOPEZ CIRCLE BLDG. A
                  FLORENCE, AZ 85132

If either party fails to appear at the hearing after proper notice, the court will take evidence from the party who
does appear and make a decision based on the information provided in the Request to Modify Child Support,
Request for Hearing and any oral testimony.

                 (Date)                                                           (Judicial Officer)

Upon receipt of the hearing date, I will immediately mail a copy of this Request for Hearing and Notice of Hearing
to the other parent or such person’s attorney as follows:

(8) NAME:

      ADDRESS:

If one of the parties is using the child support services of the Department of Economic Security, I will also
immediately mail a copy of this Request for Hearing and Notice of Hearing to:

Attorney General’s Office
Child Support Services Section
PO Box 608
Florence Arizona 85132
Site Code: 039-A

(9)

                 (Date)                                                          (Requesting Party)

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