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Minor Child (Indiana Legal Help)

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Page 1 of 3 Approved by the Coalition for Court Access
CCA-GF-1220-3014
www.indianalegalhelp.org
STATE OF INDIANA IN THE __________________ ______________ COURT
COUNTY OF _________________ CASE NO. ________________________________
IN RE THE __________________ OF:
__________________________
Minor Child
__________________________
Petitioner,
v.
__________________________
Respondent.
APPEARANCE BY UNREPRESENTED PERSON
1. My name is _________________________________ and in this case I am not represented
by a lawyer.
2. My contact information for receiving legal service of documents and case information as
required by Court Rules is:
Address:
Email address:
☐ I will accept service at the above email address.
Phone:
Fax:
OR, if in a related case, you have used the Attorney General confidential address, you may
check the box below:
☐ Attorney General confidential address
3. This is a ________ case type as defined in Administrative Rule 8(B)(3).
4. There are other cases related to this case: (If yes, please indicate below)
☐ Yes
☐ No
__________________
________________
________________
Page 2 of 3 Approved by the Coalition for Court Access
CCA-GF-1220-3014
www.indianalegalhelp.org
Caption and case number of related cases:
Caption: Case No.:
Caption: Case No.:
Caption: Case No.:
Additional information as required by local rule:
Signature
CERTIFICATE OF SERVICE
I hereby certify that I sent a copy of this document on ________________________ by
☐ e-service using the e-filing system
☐ first-class U.S. mail, postage prepaid
☐ hand delivery
to _____________________________________ at the following address:
______________________________
______________________________
______________________________
______________________________
Signature
Page 3 of 3 Approved by the Coalition for Court Access
CCA-GF-1220-3014
www.indianalegalhelp.org
STATE OF INDIANA IN THE __________________ ______________ COURT
COUNTY OF _________________ CASE NO. ________________________________
IN RE THE ___________________ OF:
__________________________
Minor Child
__________________________
Petitioner,
v.
__________________________
Respondent.
NOT FOR PUBLIC ACCESS
IN ACCORDANCE WITH INDIANA RULES ON
ACCESS TO COURT RECORDS
ATTENTION CLERK: FOR SELF REPRESENTED LITIGANTS TREAT THIS FORM AS
IF IT IS PRINTED ON LIGHT GREEN PAPER
CIVIL APPEARANCE FORM
Social security numbers of parents and minor child
Name: SS#
Name: SS#
Name: SS#
Name: SS#
Name: SS#
Name: SS#
NOT FOR PUBLIC ACCESS
__________________
________________
Page 1 of 2 Approved by the Coalition for Court Access
CCA-DC-1220-1060
www.indianalegalhelp.org
STATE OF INDIANA IN THE ________________ _______________ COURT
COUNTY OF _______________ CASE NO. ___________________________________
IN RE THE _________________OF:
____________________________
Minor Child (Paternity Only)
____________________________
Petitioner,
v.
____________________________
Respondent
VERIFIED PETITION TO MODIFY PARENTING TIME WITHOUT AGREEMENT
_________________________________, self represented, files a Verified Petition To
Modify Parenting Time Without Agreement and states in support as follows:
1. The parties’:
☐ Divorce Decree is dated ___________________.
☐ Decree Establishing Paternity is dated ___________________.
☐ parenting time rights were established without a divorce or paternity decree,
and this court has previously ordered parenting time between the above named
parties.
2. The minor child(ren) is/are named:
_____________________________________________________________________________
and ________________________________ has been ordered to pay child support in the amount
of $_____________________ per week.
3. The last order on parenting time is dated ____________________ and
_________________________________ has primary physical custody of the minor child(ren).
4. The last order on parenting time states that parenting time shall be as follows:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. A change in parenting time is in the best interest of the child(ren).
__________________
________________
Page 2 of 2 Approved by the Coalition for Court Access
CCA-DC-1220-1060
www.indianalegalhelp.org
6. I am asking the Court to hold a hearing and to enter a parenting time order:
☐ in accordance with the Indiana Parenting Time Guidelines OR
☐ as follows:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
WHEREFORE the undersigned prays that the Court set this matter for hearing, that the
Court modify the parenting time as requested, and for all other just and proper relief.
I affirm under penalties for perjury that the foregoing representations and statements
are true.
Date: _____________________________ ____________________________________
Signature
__________________________________
Printed Name
CERTIFICATE OF SERVICE
I hereby certify that I sent a copy of this document on ________________________ by
☐ e-service using the e-filing system
☐ first-class U.S. mail, postage prepaid
☐ hand delivery
to _____________________________________ at the following address:
______________________________
______________________________
______________________________
______________________________
Signature
Page 1 of 1 Approved by the Coalition for Court Access
CCA-DC-1220-1061
www.indianalegalhelp.org
STATE OF INDIANA IN THE __________________ _______________ COURT
COUNTY OF _________________ CASE NO. ____________________________________
IN RE THE ___________________ OF:
_____________________________
Minor Child (Paternity Only)
_____________________________
Petitioner,
v.
_____________________________
Respondent
ORDER SETTING HEARING
Comes now _____________________________________, self represented, having filed a
Verified Petition To Modify Parenting Time Without Agreement, and the Court finds that the matter
should be set for hearing.
IT IS THEREFORE ORDERED that this matter shall be heard on
__________________________________________________________________________________.
_____________________________________
Judicial Officer
Distribution:
_________________________________ ___________________________________
_________________________________ ___________________________________
_________________________________ ___________________________________
_________________________________ ___________________________________
__________________
________________
Page 1 of 1 Approved by the Coalition for Court Access
CCA-DC-1220-1062
www.indianalegalhelp.org
STATE OF INDIANA IN THE ______________ _______________ COURT
COUNTY OF _________________ CASE NO. _________________________________
IN RE THE _________________OF:
____________________________
Minor Child (Paternity Only)
____________________________
Petitioner,
v.
____________________________
Respondent
ORDER MODIFYING PARENTING TIME
The Court, having reviewed the Verified Petition to Modify Parenting Time Without
Agreement, now enters the following order:
1. ________________________ filed a Verified Petition to Modify Parenting Time on
_____________________________.
2. The Court set this matter for hearing, and __________________________ appeared
in person and self represented/with counsel and ____________________________ appeared self
represented/with counsel. Evidence was heard and concluded.
3. _____________________________:
☐ shall have parenting time in accordance with the Indiana Parenting Time Guidelines OR
☐ a deviation from the Indiana Parenting Time Guidelines is warranted and parenting
time shall be as follows:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_________________________________________________________________________
SO ORDERED _______________________________________________.
__________________________________________
Judicial Officer
Distribution to:
______________________________ _______________________________
______________________________ _______________________________
______________________________ _______________________________
______________________________ _______________________________
__________________
________________
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Minor Child (Indiana Legal Help)

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Completed 31 December 2021

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