________
________
Telephone: ________
Email: ________
________
________
________
________
________
RE: Request for Administrative Review and Modification of Child Support Order
Case/Docket No.: ________
Court/Agency of Jurisdiction: ________
State: ________
Obligor (Paying Parent): ________
Obligee (Receiving Parent): ________
To Whom It May Concern:
§ 1. Purpose of Request. Pursuant to applicable state law and the federal periodic-review provisions of Title IV-D of the Social Security Act (42 U.S.C. § 666(a)(10)) and 45 C.F.R. § 303.8, I respectfully request a review and, if warranted, a modification of my existing child support obligation entered in the above-referenced matter for my minor child, ________, born ________.
§ 2. Current Order. Under the current order, I am obligated to pay to ________ child support in the amount of $________ (________) per month.
§ 3. Origin of the Obligation. This support obligation was established by a divorce decree/order entered on ________ by the court identified above.
§ 4. Basis for Review. I request this review for the following reason(s): (a) a substantial period of time has elapsed since the order was last reviewed, the most recent review having occurred on or about ________; and (b) there has been a substantial and continuing change in circumstances, as more particularly described below:
________
§ 5. Supporting Documentation. In support of this request, and consistent with the financial-disclosure requirements applicable to support proceedings, I enclose the following supporting documentation:
________
§ 6. Contact Information for Obligor. Should you require any additional information or documentation from me, or wish to schedule a conference or hearing, please contact me at the address set forth above or by the following means:
________
§ 7. Contact Information for Obligee. The other parent, ________, may be contacted at the following address:
________
Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu fugiat nulla pariatur lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation.
§ 9. Verification. I declare under penalty of perjury under the laws of the State of ________ that the foregoing is true and correct to the best of my knowledge and belief.
Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse.
Sincerely,
________
Dated: ________
Enclosures: ________