Fillable Minor Child (paternity only) Petitioner, (Indiana Legal Help)

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Minor Child (paternity only) Petitioner, (Indiana Legal Help)

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Page 1 of 3 Approved by the Coalition for Court Access
CCA-DC-0519-3013
STATE OF INDIANA ) IN THE ___________________ _____________ COURT
)SS:
COUNTY OF _________________ ) CASE NO. __________________________________
IN RE THE ____________________ OF:
_______________________________
Minor Child (paternity only)
_______________________________
Petitioner,
v.
_______________________________
Respondent
APPEARANCE BY UNREPRESENTED PERSON IN CIVIL CASE
This Appearance Form must be filed on behalf of every party in a civil case.
1. My name is _________________________________ and I am:
☐ Initiating (filing)
☐ Responding (answering or defending)
☐ Intervening
in this case I am not represented by a lawyer.
2. Contact information for receiving legal service of document and case information as required by Court
Rules. (NOTE: If you are the Initiating Party and this case, or a related case, involves a protection
from abuse order, a workplace violence restraining order, or a no-contact order, you must provide an
address for the purpose of legal service of documents. But, that address should not be one that exposes
your location.)
Address:
Email address:
☐ I will accept service at the above email address.
Phone:
Fax:
__________________
_________________
Page 2 of 3 Approved by the Coalition for Court Access
CCA-DC-0519-3013
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).
(The Clerk will tell you the case type if you do not know it, so you may handwrite your response at the
Clerk’s Office.)
4. This case involves child support issues and the names and social security numbers of all family
members are on a separately attached document marked “Not For Public Access In Accordance With
Administrative Rule 9)
5. There are related cases: (If yes, please indicate below)
☐ Yes
☐ No
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 Appearance by first class mail to the opposing party’s attorney,
or to the opposing party if the opposing party is not represented by an attorney on
______________________________.
Signature
Page 1 of 1 Approved by the Coalition for Court Access
CCA-DC-0320-1069
www.indianalegalhelp.org
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. IF E-FILED, FILE AS A CONFIDENTIAL
DOCUMENT.
STATE OF INDIANA IN THE ____________________ ___________ COURT
COUNTY OF __________________ CAUSE NO: _____________________________
IN THE ________________OF
_______________________
Minor Child (paternity only)
_______________________
Petitioner
vs.
_______________________
Respondent
CIVIL APPEARANCE FORM
Social security numbers of all family members in cases involving child support
Name: ______________________________________SS#________________________________
Name: ______________________________________SS#________________________________
Name: ______________________________________SS#________________________________
Name: ______________________________________SS#________________________________
Name: ______________________________________SS#________________________________
Name: ______________________________________SS#________________________________
NOT FOR PUBLIC ACCESS
__________________
_____
Page 1 of 4 Approved by the Coalition for Court Access
CCA-DC-0519-1006
STATE OF INDIANA ) IN THE ______________ _______________ COURT
)SS:
COUNTY OF __________________ ) CASE NO. ___________________________________
IN RE THE _________________ OF:
_______________________________
Minor Child (paternity only)
_______________________________
Petitioner,
v.
_______________________________
Respondent.
JOINT VERIFIED PETITION TO MODIFY CHILD SUPPORT DUE TO EMANCIPATION OF
MINOR CHILD(REN) AND AGREED ENTRY
Comes now ________________________________, self represented, and
__________________________________, self represented, and hereby files their Joint Verified Petition
to Modify Child Support Due to Emancipation of Minor Child(ren), and states as follows:
1. That parties have ______ minor child(ren), namely:
Name Date of birth
2. On __________________, this Court ordered that _______________________________
pay child support to _________________________________ in the weekly amount of ______________
for the above name child(ren) effective on __________________.
3. The following child(ren) is/are emancipated:
___________________________________________________________________________________
__________________
_________________
Page 2 of 4 Approved by the Coalition for Court Access
CCA-DC-0519-1006
4. The reason that my child(ren) is/are emancipated as follows:
☐ _____________________________ has turned nineteen (19) years of age.
☐ _____________________________ is at least eighteen (18) years of age; has not
attended secondary or post-secondary school for the past four (4) months and is not enrolled in a secondary
or post-secondary school; and is or is capable of supporting himself/herself through employment.
☐ _____________________________ has joined the United States armed services.
☐ _____________________________ has married.
☐ _____________________________ is not under the care or control of either parent
nor an individual or agency approved by the court.
5. The date upon which my child(ren) became emancipated was ___________________.
6. My child support obligation should be modified because of the emancipation of my
child(ren), _______________________________________________________________________.
7. _____________________________ will pay child support to
_____________________________ in the amount of $ ___________________ per week for the above
named, unemancipated children.
8. The modification of my support obligation should be retroactive to the date(s) stated in
Paragraph 5, above.
9. Arrearages are not determined at this time and are reserved for a later date.
10. All support payments shall be made through the County Clerk’s Officer (cash payments
only) or the State Central Collection Unit PO Box 7130, Indianapolis, Indiana 46207-7130 (any payments
other than cash). The court shall issue and immediately activate an Income Withholding Order pursuant
to IC § 31-16-15 to any employer or income provider to the child support Obligor.
11.
☐_____________________________ shall maintain medical, dental and optical
insurance as available through employment, or Health Insurance Marketplace, or by government provided
insurance for the minor child(ren).
-OR-
Page 3 of 4 Approved by the Coalition for Court Access
CCA-DC-0519-1006
☐ Health insurance for the child(ren) is not available to either parent at a reasonable
cost, therefore neither party is ordered to provide health insurance at this time. In the event that health
insurance for the child(ren) becomes available at a reasonable cost to one or both of the parties, the party
to whom such coverage is available shall obtain coverage for the children within a reasonable time after
such coverage becomes available.
12. _____________________________ will be responsible for the first $_______________
per year of uninsured health and medical, dental, optical, hospital and prescription expenses for the
minor child(ren). Thereafter, __________________________ shall be responsible for the ____% of
annual uninsured health and medical, dental, optical hospital and prescription expenses for minor
child(ren), and Respondent shall be responsible for the ____% of annual uninsured health and medical,
dental, optical hospital and prescription expenses for minor child(ren)
13.
☐_____________________________ shall be entitled to claim the minor child(ren) for
federal, state, and local income tax purposes on an annual basis. The parties shall cooperate to sign all
necessary documents that will allow the party claiming the exemption to do so.
The non-custodial parent’s right to this exemption is conditioned on them being 95% compliant in
their support by January 31 of their tax year pursuant to IC § 31-16-6-1.5(d). The custodial parent shall
take all actions necessary to release their claim to the exemption in the manner required under Section
152(e) of the Internal Revenue Code.
-OR-
☐ Petitioner and Respondent shall each be entitled to claim the minor child(ren) for
federal, state and local income tax purposes in alternating years. Petitioner shall be entitled to claim the
minor child(ren) in the year __________, and every ______ year thereafter. Respondent shall be entitled
to claim the minor child(ren) in the year ________ and every ________ year thereafter. The parties shall
cooperate to sign all necessary documents that will allow the party claiming the exemption to do so.
The non-custodial parent’s right to this exemption is conditioned on them being 95% compliant
in their support by January 31 of their tax year pursuant to I C§ 31-16-6-1.5(d). The custodial parent shall
take all actions necessary to release their claim to the exemption in the manner required under Section
152(e) of the Internal Revenue Code.
14. Parties waive their right to a hearing.
_______
____________
Page 4 of 4 Approved by the Coalition for Court Access
CCA-DC-0519-1006
WHEREFORE,_____________________________ and ________________________________
request that this Court declare our child(ren) emancipated, modify the child support obligation, and order
all other further relief that is just and proper in the premises.
I affirm under the penalties of perjury that the foregoing representations are true.
____________________________________ ____________________________________
Signature Date
STATE OF INDIANA )
)SS:
COUNTY OF__________________ )
Before me, ___________________________a notary public in and for __________________________
County, State of Indiana, personally appeared ___________________________________, and he/she
having been first duly sworn upon his/her oath, says that the facts all alleged in the foregoing instrument
are true.
Date _____________________________ __________________________________________
Notary Public
My Commission Expires: ___________________________
I affirm under the penalties of perjury that the foregoing representations are true.
____________________________________ ____________________________________
Signature Date
STATE OF INDIANA )
)SS:
COUNTY OF__________________ )
Before me, ___________________________a notary public in and for __________________________
County, State of Indiana, personally appeared ___________________________________, and he/she
having been first duly sworn upon his/her oath, says that the facts all alleged in the foregoing instrument
are true.
Date _____________________________ __________________________________________
Notary Public
My Commission Expires: ___________________________
Page 1 of 3 Approved by the Coalition for Court Access
CCA-DC-0519-1007
STATE OF INDIANA ) IN THE ___________________ _____________ COURT
)SS:
COUNTY OF _________________ ) CASE NO. __________________________________
IN RE THE ____________________ OF:
_______________________________
Minor Child (paternity only)
_______________________________
Petitioner,
v.
_______________________________
Respondent
ORDER GRANTING MODIFICATION OF CHILD SUPPORT DUE TO EMANCIPATION OF
MINOR CHILD(REN)
Comes now, ________________________, self represented, and ___________________________,
self represented, having filed a Joint Verified Petition to Modify Child Support Due to Emancipation of Minor
Child(ren) and Agreed Entry. The Court, having read said pleading, now finds that the child support
obligation should be modified because of the emancipation of the minor child(ren).
IT IS THEREFORE ORDERED that:
1. ____________________________________ was emancipated on ___________________.
2. ____________________________________ is to pay child support in the amount of
$___________________ per week, effective on _________________________.
3. All support payments shall be made through the County Clerk’s Office (cash payments only)
or the State Central Collection Unit Po box 7130, Indianapolis, Indiana 46207-7130 (any payments other
than cash). The court shall issue and immediately activate an Income Withholding Order pursuant to IC §
31-16-15 to any employer or income provider to the child support Obligor.
4. Arrearages are not determined at this time and are reserved for a later date.
5.
☐_____________________________ shall maintain medical, dental and optical insurance
as available through employment, or Health Insurance Marketplace, or by government provided insurance
__________________
_________________
Page 2 of 3 Approved by the Coalition for Court Access
CCA-DC-0519-1007
for the minor child(ren).
-OR-
☐ Health insurance for the child(ren) is not available to either parent at a reasonable
cost, therefore neither party is ordered to provide health insurance at this time. In the event that health
insurance for the child(ren) becomes available at a reasonable cost to one or both of the parties, the party to
whom such coverage is available shall obtain coverage for the children within a reasonable time after such
coverage becomes available.
6.
☐_____________________________ shall be entitled to claim the minor child(ren) for
federal, state, and local income tax purposes on an annual basis. The parties shall cooperate to sign all
necessary documents that will allow the party claiming the exemption to do so.
The non-custodial parent’s right to this exemption is conditioned on them being 95% compliant in
their support by January 31 of their tax year pursuant to IC § 31-16-6-1.5(d). The custodial parent shall take
all actions necessary to release their claim to the exemption in the manner required under Section 152(e) of
the Internal Revenue Code.
-OR-
☐Petitioner and Respondent shall each be entitled to claim the minor child(ren) for federal,
state and local income tax purposes in alternating years. Petitioner shall be entitled to claim the minor
child(ren) in the year __________, and every ______ year thereafter. Respondent shall be entitled to claim
the minor child(ren) in the year ________ and every ________ year thereafter. The parties shall cooperate
to sign all necessary documents that will allow the party claiming the exemption to do so.
The non-custodial parent’s right to this exemption is conditioned on them being 95% compliant
in their support by January 31 of their tax year pursuant to I C§ 31-16-6-1.5(d). The custodial parent shall
take all actions necessary to release their claim to the exemption in the manner required under Section
152(e) of the Internal Revenue Code.
7. ________________________________ will be responsible for the first $_______________
per year of uninsured health and medical, dental, optical, hospital and prescription expenses for the minor
child(ren). Thereafter, Petitioner shall be responsible for ____% of annual uninsured health and medical,
_______
____________
Page 3 of 3 Approved by the Coalition for Court Access
CCA-DC-0519-1007
dental, optical hospital and prescription e
xpenses for minor child(ren), and Respondent shall be responsible
for ____% of annual uninsured health and medical, dental, optical hospital and prescription expenses for
minor child(ren).
So ordered _________________________________
____________________________________
Ju
dicial Officer
Distribution:
________________________________________
________________________________________
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Completed 31 December 2021

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