LaGrange County Child Support
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Request for Modification of Child Support
LaGrange County Prosecutor's Office
105 North High Street
LaGrange, IN 46761
Both custodial & non-custodial parties may request a modification for support. Support may increase or decrease depending on the changes. Parents may wish to use a Child Support Calculator online which can give an estimate of the weekly child support payments.
There must be at least a 20% change in support or otherwise the support will not be modified.
https://www.in.gov/courts/services/child-support-calculator/
Your Name
Case Number
Other Party Name
Street Address
ZIP
State
Your Phone Number
Your Email Address:
Date Since Last Change (
must be at least 12 months since last modification was filed.)
(mm-dd-yyyy)
Change in Income
No longer working:
Last day worked
Laid-off
Let go
Quit
Other
Change in amount of income:
CURRENT WEEKLY GROSS INCOME:
Less Hours
Part-Time
Changed Jobs
Childcare Expenses:
Are you paying childcare expenses?
Yes
No
If yes, how much per week?
Overnight Visits
Does the non-custodial parent have overnight visitation with the child(ren)?
Yes
No
If yes, how many per month? If you have multiple children, please enter each child's name, along with the number of overnights that each child stays with the non-custodial parent:
Add section
Name
Number of overnights
Remove
Provide a statement from caregiver for the weekly amount paid
Insurance Information:
How is the child(ren) covered for insurance?
Custodial Parent
Non-Custodial Parent
Other
Medicaid
How many people are covered under this policy?
What is the cost of coverage per month?
Medical $
Dental $
Vision $
Other Children:
Do you have any other children that are not included in this case?
Yes
No
If yes, please complete the following:
Add section
Name
DOB
(mm-dd-yyyy)
Does the child live with you?
Do you pay support for this child?
Remove
Other: Please Explain:
Provide at least 4 of your most recent paystubs AND a copy of last year's W2's
Please note: A review for modification will not be done until financial documents are received.
Attach Document (PDF, JPG, PNG, GIF, TIFF Only)
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