Use this template/form to file for child custody in the state of Colorado
Text version of this Form
———————– Page 1———————–
District Court Denver Juvenile Court
_________________________________ County, Colorado
Court Address:
In re:
The Marriage of:
Parental Responsibilities concerning:
______________________________________________________
Petitioner:
and COURT USE ONLY
Co-Petitioner/Respondent:
Attorney or Party Without Attorney (Name and Address): Case Number:
Phone Number: E-mail:
FAX Number: Atty. Reg.#: Division Courtroom
VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO §14-10-122, C.R.S.
Note to Responding Party: If you disagree with this Motion, the Colorado Rules of Civil Procedure
allow you to file a written response with the Court which must be filed within 21 days of the date this
Motion was served on you or mailed to you.
The Petitioner Co-Petitioner/Respondent states the following for the purpose of modifying child support.
1. Information about Petitioner: Date of Birth: __________________________
Current Mailing Address: __________________________________________________________________
City & Zip: ______________________________________________________________________________
Home Phone #: ___________________ Work Phone #: __________________ Cell #: __________________
2. Information about Co-Petitioner/Respondent: Date of Birth: __________________________
Current mailing address: ___________________________________________________________________
City & Zip: ______________________________________________________________________________
Home Phone #: ___________________ Work Phone #: ___________________ Cell #: _________________
3. The parties have ______ minor child(ren):
Full Name of Child Present Address Sex Date of Birth
4. Under the current Support Order, the Petitioner has________ overnights per year with the children and the
Co-Petitioner/Respondent has ________ overnights per year with the children.
5. Under the current child support order, the Petitioner’s Co-Petitioner’s/Respondent’s child support
obligation is $ _________and is paid weekly bi-weekly twice a month monthly Other: ________ .
JDF 1403 R1-12 VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO §14- 10-122, C.R.S. Page 1 of 3
———————– Page 2———————–
6. (Check only if applicable.) The current support order does not contain a provision regarding medical
insurance (medial, dental, and/or vision) coverage.
7. A change in the current Support Order is appropriate because of the following change(s) in circumstance(s).
Please check the appropriate box. Day Care costs Change in Income
Change in Parenting Time Change in Residence Emancipation of a Child
Medical insurance coverage Other: ______________________________________________________
Describe why you are requesting the modification.
8. The new child support obligation that I am requesting is is not more than a 10% change from the current
child support order. The proposed child support obligation should be $____________ to be paid weekly
bi-weekly twice a month monthly other: ________ .
9. I/We have completed a child support worksheet that shows what the new child support obligation should be.
The child support worksheet is is not attached to this Motion.
10. I/We have attached current Sworn Financial Statements to this Motion.
11. Is either party currently receiving public assistance? Yes No If you checked Yes, answer the following:
Name of Person Receiving Benefit Name of County or State
12. Is either party receiving child support enforcement services. Yes No If Yes, identify
____________________________ (County) ______________________ (State).
13. Does either parent live in another state? Yes No If Yes, identify __________________________
(name of person) and ___________________________________ (City and State) they are currently living in.
14. (Check only if applicable.) I request a change in the current tax exemption because of the reallocation of
the costs of raising the dependent children, pursuant to §14-10-115(12), C.R.S.
I respectfully request that this Court enter an Order modifying the Petitioner’s Co-Petitioner’s/Respondent’s
child support obligation as described above.
JDF 1403 R1-12 VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO §14- 10-122, C.R.S. Page 2 of 3
———————– Page 3———————–
VERIFICATION AND ACKNOWLEDGMENT
I swear/affirm under oath that I have read the foregoing Motion and that the statements set forth therein are true
and correct to the best of my knowledge.
_____________________________________ ____________________________________________
Signature of Attorney, if applicable Date Petitioner or Co-Petitioner/Respondent
____________________________________________
Address
____________________________________________
City, State, Zip Code
____________________________________________
(Area Code) Telephone Number (home)
____________________________________________
(Area Code) Telephone Number (work)
Subscribed and affirmed, or sworn to before me in the County of ______________________ , State of
__________________ , this ___________ day of _______________ , 20______ .
My Commission Expires: ___________________ ____________________________________________
Notary Public/Deputy Clerk
CERTIFICATE OF SERVICE
I certify that on ________________________ (date) a true and accurate copy of the Verified Motion to Modify
Child Support was served on the other party by:
Hand Delivery, E-filed, Faxed to this number: _______________________ , or
by placing it in the United States mail, postage pre-paid, and addressed to the following:
To: _______________________________________
_______________________________________
_______________________________________ ______________________________________
Your signature
If the Child Support Enforcement Unit is involved in the case; you must provide them a copy of this Motion.
JDF 1403 R1-12 VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO §14- 10-122, C.R.S. Page 3 of 3