Request To Adjust An Income Withholding Order

My Name: Mailing Address: City, State, Zip: Phone Number: Representing Self SUPERIOR COURT OF ARIZONA, COUNTY OF COCONINO Petitioner's Name on the Petition for divorce, legal separation, or parenting time: Case Number: DO REQUEST TO ADJUST AN INCOME WITHHOLDING ORDER Respondent's Name: ATLAS Number: I am the [ ] Petitioner or [ ] Respondent. I am the obligor on the Income Withholding Order dated . I ask the court to change that Order as follows: Change Current Child Support Past-Due Child Support Current Cash Medical Support Past-Due Cash Medical Support Current Spousal Support Past-Due Spousal Support From $ $ $ $ $ $ $ $ $ $ $ $ To I still owe money on this Order, but I ask for this change because: [] [] [] The amount is listed incorrectly on the current Income Withholding Order. I have paid all past-due court-ordered [ ] child support and/or [ ] spousal support. My court-ordered child support obligation has ended for all children because: Is at least 18 and not in Has been Child's Name high school Is married adopted [] [] [] [] [] [] [] [] [] [] [] [] [ ] Other: Current Child Support Order Date: Monthly Amount: $ American LegalNet, Inc. www.FormsWorkFlow.com Is deceased [] [] [] [] Page 1 of 2 Revised December 2012 Coconino County Law Library and Self-Help Center Forms [] My court-ordered spousal support obligation has ended because: [] The other party is [ ] remarried or [ ] deceased. [] Other: Other reason the Income Withholding Order needs to be changed: [] Date: My Signature: Notice to the Other Party: If you do not agree with this Request, you have 20 days (30 days if you were served outside of Arizona), including weekends and holidays, starting the day after you were served, to file a written request for a hearing. To ask for a hearing, see the Self-Help Center packet Changing or Stopping an Income Withholding Order: Response. Page 2 of 2 Revised December 2012 American LegalNet, Inc. www.FormsWorkFlow.com Coconino County Law Library and Self-Help Center Forms