National Divorce & Bankruptcy Center

Modification Worksheet - Order Form

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This will be a Mofication of

FILED in the state of

Filed By

 CHILD SUPPORT OR CUSTODY MODIFICATION:

MOST OF THE REQUIRED INFORMATION IS CONTAINED IN YOUR ORIGINAL
CHILD SUPPORT ORDER.

PROVIDE THE FOLLOWING FOR THE ORDER TO BE MODIFIED
Title of Order(i.e.Agreed Final Decree of Divorce)

County and State where order was issued
Court that issued the order(i.e. 810th District, County Court etc.)
Case/Order Number
Date order was issued

Does the mother have joint or sole physical custody?
 No court orders for custody
 Mother is Joint Managing Conservator
 Mother is Sole Managing Conservator

Where the father's parental rights terminated by the court?
 Yes
 No

Is the father court ordered to pay child support?
 Yes
 No

If Court ordered; child support is:
 None: There is no court order for child support
 Current (paid as ordered)
 Delinquent in the amount of
 Never paid any child support even though court ordered

Does the father have court ordered visitation?:
 No: There is no court ordered visitation
Yes: Father has visitation
Yes: Father has only supervised visitation

B>What is your full legal name?

Are you the Husband or the Wife?
Husband Wife

What is yoursocial security number?

What is the state and number of your driver's license?
(required in most states)

What is your date of birth?

How old are you?

What is your address?
Street Address
City
County,(NOT country - NOT - USA)
Your E-mail address
Your Telephone number [include area code]

Are you in the Military?
No Yes

Name of Employer (if any)

Address of Employer

Information About other parent
**Fill in as much information as you have ***

What is the other parents full legal name?

other parents's date of birth?
other parents's Age

other parent's social security number?
other parent's driver's license? (required in most states)

What is the other parent's address? If you live at the same address, just type "same"
Street Address
City
County, (NOT country - NOT - U.S.A.) State, Zip
Telephone number [include area code]

Name of Employer (if any)

Address of Employer
CHILD SUPPORT MODIFICATIONS: ___***By Agreement: There will be NO child support ordered to be paid by either party**** Is the modification of child support to be by mutual agreement of the parents? yes no Are you seeking to increase the child support payments? INPUT TYPE="radio" NAME="agreed" VALUE="Yes"> yes no Are you seeking to decrease (lower) the child support payments? INPUT TYPE="radio" NAME="agreed" VALUE="Yes"> yes no Number of children and support as percentage of Obligor's income:(circle one) 1 CHILD = 20%; 2 CHILDREN = 25%; 3 CHILDREN = 30%; 4 CHILDREN = 35% CUSTODY CHANGES: Who is to be the "NEW" Managing Conservator/Custodial parent of the child(ren) . Does the child already live with the "new" managing conservator/Custodial parent? INPUT TYPE="radio" NAME="agreed" VALUE="Yes"> yes no Is the modification (change) in conservatorship to be by mutual agreement of the parties? INPUT TYPE="radio" NAME="agreed" VALUE="Yes"> yes no SUBSTANTIAL AND MATERIAL CHANGE IN CIRCUMSTANCES: (mark and "X" for all that apply to your situation)

Credit Card Account Information

For payment by credit card, please complete the information below. This will enable us to begin processing your paperwork immediately.

Checking Account Debit Card (MasterCard & Visa only)
*You may use your MasterCard or Visa checking Account Debit Card by completing the following credit card information. This will allow your checking account to be debited and processing to be done immediately.

Which Credit Card Will You Be Using?
MasterCard
VISA

Credit Card Number
Expiration Date

Card Holder's Name (as it appears on the card)

Street Address (As it appears on the card)

City/State (As it appears on the card)
Zip code [As it appears on the card]

Charge my credit card in the amount of:

NON-TEXAS RESIDENTS

$200 [*includes delivery by e-mail or 1st Class US Postal]
$200 [*includes delivery by e-mail or 1st Class US Postal]
$200 [*includes delivery by e-mail or 1st Class US Postal]
$205.00.00 Priority Mail USP Shipping [2-3 day delivery]($205.00 $5 surcharge)
$200.00 Overnight FedExpress Shipping (Fed Ex Charges billed by Fed Ex - no surcharge)


TEXAS RESIDENTS: [Includes TX state sales tax of $12.29 included below]

 $200.00 [*includes delivery by e-mail or 1st Class US Postal]

***RETURN YOUR COMPLETED PAPERWORK
(including the following "IMPORTANT INFORMATION" STATEMENT) WITH PAYMENT OF $200 plus $50.00 for each additional child Document Processing Fee
PAYABLE TO:
National Divorce And Bahruptcy
3037 F Cunningham Dr.
Wichita Falls,
Texas 76308

You may also'call in' your credit card account information to
(940) 692-1768.

Select the format for file transfer below.

If
In order to process and return mail your paperwork to you in less than 48 hours; Payment is limited to Money Orders or Cashiers Checks
Your COMPLETED PAPERWORK, - READY TO BE FILED - (as well as all procedural information necessary to complete the modification process) will be processed and mailed to you, via U.S. Postal, WITHIN 48 HOURS of receipt of your order information and payment. Delivery time is noramlly 1-2 days.


All documents originate in the legal standard Word Perfect 6.0 format. Your completed file can be e-mail 'delivered' to you for faster access in wordperfect format which you can then simply print out.

E-mail attach my document file to __________________@___________________


Our net home: http://www.divorcehelp.net/
e-mail us at: divorcehelp@sw.rr.com | Phone: (940)  692-1768|
I ACKNOWLEDGE THAT I AM REPRESENTING MYSELF IN THIS ACTION AND THAT I HAVE NOT RECEIVED 'LEGAL ADVICE' FROM NATIONAL DIVORCE & BANKRUPTCY CENTER (a division of PRO SE PUBLICATIONS) AND THAT ALL STATEMENTS AND PHRASES INSERTED ON THESE TYPING INFORMATION FORMS ARE THE WORK AND WORDS OF THE CUSTOMER ALONE.
I HAVE READ THE ABOVE STATEMENT AND UNDERSTAND ITS TERMS;

Signature:____________________________________
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If you wish to mail your payment,please make check or money order payable to:

National Divorce & Bankruptcy Center Center
3037 F Cunningham Drive,  Wichita Falls, Texas 76308
Phone: (940) 692-1768

E-Mail: divorcehelp@sw.rr.com

We are not attorneys and can not give legal advice. The information we provide shall not be substituted for legal adivce.