Nj Child Support Modification Details

Nj Court Form 11487 is a document used to request or ask the court for something. This could be anything from a modification of a judgement, to waiver of fees, to setting aside default judgement. There are many reasons why you might need to use this form, and it's important that you complete it correctly so that your request can be processed as quickly as possible. In this post, we'll walk you through how to fill out Nj Court Form 11487 so that you can submit your request in the correct manner.

You might find it beneficial to know how much time you will need to fill out this nj court form 11487 and just how long the document is.

QuestionAnswer
Form NameNj Court Form 11487
Form Length16 pages
Fillable?No
Fillable fields0
Avg. time to fill out4 min
Other namesfd application nj, nj child support modification form, request to modify non dissolution fd court order nj, application for modification of court order nj

Form Preview Example

Family – Chancery

How to file a request to modify a Non-Dissolution “FD” Court Order previously issued by the court February 2013

How to file a request to modify a Non-Dissolution “FD” Court Order previously

issued by the court

Superior Court of New Jersey - Chancery Division - Family Part

Who Should Use This Packet?

You can use this packet if your docket number starts with the letters FD, and you have an order from the court that you want to change. You can also use this packet if you want to respond to the modification request filed by the other party. Some types of modifications you can request with this packet are:

Change(s) to an existing Child/Spousal Support Order

Enforcement of the Current Support Order

Change of existing Custody/Parenting Time Court Order

Request to Relocate the Child(ren)/Opposition to Relocation

Request to have a Bench Warrant/Detainer lifted (Incarcerated Defendants Only)

Emergent Application (Order to Show Cause) - Additional Forms Required. Must Go to Courthouse to File.

Motion for Reconsideration of an FD Order.

ONLY use this packet if your case begins with letters FD.

Kit Revised: 02/01/2013, CN 11487 (How to file a request to modify a Non-Dissolution “FD” Court Order)

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Things to Think About Before You Try to Represent Yourself in Court

Try to Get a Lawyer

The court system can be confusing and it is a good idea to get a lawyer if you can. If you cannot afford a lawyer, you may contact the legal services program in your county to see if you qualify for free legal services. Their telephone number can be found in your local yellow pages under “Legal Aid” or “Legal Services.”

If you do not qualify for free legal services and need help in locating an attorney, you can contact the bar association in your county. The telephone number can also be found in your local yellow pages. Most county bar associations have a Lawyer Referral Service. The county bar association Lawyer Referral Service can supply you with the names of attorneys in your area willing to handle your particular type of case and sometimes consult with you for a reduced fee.

There are a variety of organizations of minority lawyers throughout New Jersey, as well as organizations of lawyers who handle specialized types of cases. Ask the Family court staff in your county for a list of lawyer referral services that include these organizations.

What You Should Expect If You Represent Yourself

While you have the right to represent yourself in court, you should not expect special treatment, help, or attention from the court. The following is a list of things court staff can and cannot do for you.

We can explain and answer questions about how the court works.

We can tell you what the requirements are to have your case considered by the court.

We can give you some information from your case file.

We can provide you with samples of court forms that are available.

We can provide you with guidance on how to fill out forms.

We can usually answer questions about court deadlines.

We cannot give you legal advice. Only your lawyer can give you legal advice.

We cannot give you an opinion about what will happen if you bring your case to court.

We cannot recommend a lawyer, but we can provide you with the telephone number of a local lawyer referral service.

We cannot talk to the judge for you about what will happen in your case.

We cannot let you talk to the judge outside of court.

We cannot change an order issued by a judge.

Kit Revised: 02/01/2013, CN 11487 (How to file a request to modify a Non-Dissolution “FD” Court Order)

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Keep Copies of All Papers

Make and keep copies for yourself, of any signed orders, written agreements, Case Information Statements, and other important papers that relate to your case.

These Papers Are for Filing an Application to Modify a Court Order in a “FD” case

The word application used in this packet means a written request in which you ask the court to change or enforce an order it has already made. The court will change an order only if important facts or circumstances have changed from the time the order was issued. This is different from an appeal.

Notice to Appear

The court will notice the plaintiff, defendant, listed interested parties, and any attorney connected to your case, through the normal court noticing procedures. You must provide the court with the most current address of the other party that you know and the name of the attorney (if you know it) when you file this modification with the court. All papers you send will be shared with the other party with the notice to appear, unless the court rule prohibits this information from being shared. The plaintiff, defendant, interested parties, and attorneys (if known) will receive a notice to appear when the case is scheduled for court. Your appearance is mandatory.

If You Want to File an Appeal, Not an Application

An appeal is a written request asking a higher court to look at the decision of the judge and change that judge's decision. You must make that written request for an appeal within 45 days after the judge decided the case and signed a judgment in the Superior Court.

If you want to file an appeal of a court order, do not use this packet of materials. Instead you should contact the Appellate Division in writing or by phone at:

Appellate Division, Superior Court

Hughes Justice Complex

P.O. Box 006,

Trenton, NJ 08625-0006

Their telephone number is (609) 292-4822. The Appellate Division staff will provide you with information on how to file an appeal.

“My case is an emergency” (Emergent

Application Order to Show Cause)

An emergent hearing in family court is designed to protect children from substantial and irreparable harm if someone is not restrained for doing something right now. You must file for

an emergent hearing at the courthouse. You

can not file for an emergent hearing through the mail. Only a judge can determine if your case will qualify as an emergency. If you are denied an emergency hearing, your case may continue under the normal case process.

Court Terms Used in FD

This packet contains a list of frequently used terms the court uses in processing FD cases. They may help you understand the FD application process and how the court handles an FD case.

Where to Mail or Bring Your Papers

You should mail or bring your completed packet to the court house where the child of spouse lives. When mailing, make sure you specify the “Family Division” and “Non-Dissolution Intake” in your address to insure your papers arrive at the correct department in the court.

Sample Address

(Name of County) Courthouse Family Division Non-Dissolution Intake 1234 Street

PO Box#

City, State, Zip code

All court house addresses can be found on njcourts.com

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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Other Papers That You May Have to Complete Depending on Your Case

Each case has unique circumstances that may require different information. Read the next section

carefully and include any documents that will be needed for your particular case. Failure to complete certain required documents may result in your application being returned as “deficient” which will delay

you getting your day in court.

Confidential Litigant Information Sheet (included in this kit)

This form must be completed by the person filing this application to modify a court order. Failure to do so will result in your papers being returned to you marked “deficient”. This will cause a

delay in your case being scheduled for court.

You must complete the entire form whenever you request to reopen your case and submit it with your papers to the court. If something does not apply to you, put “n/a”. Do not leave any blank spaces. This

form is confidential and will not be shared with the other party. Each party is required to complete his/her own Confidential Litigant Information Sheet and file it with the court.

Federal Child Support Services Application (IV-D Child Support Program)

You should complete this application if you are applying to establish paternity or child support.

Applying for support services under the federal child support program insures your case will be enforced through the court’s Probation Division. You may complete this application on line and it will be

forwarded to the court through the internet. Follow the instructions on the NJchildsupport.org website. This application is in addition to the other court papers you must file to establish your court case.

Summary Form for Financial Information

This form must be completed if you are requesting establish or modify child support in an FD case.

You must complete this form if you are filing to establish child support. You must complete the entire form. If something does not apply to you put “n/a”. Do not leave any blank spaces. This completed form

must be included in your packet submitted to the court. This form will be shared with the other party pursuant court rule (R. 5:5-3.). The other party must complete this same form and file it with the court. The court will share this information with the filing party at the court hearing.

Case Information Statement (CIS)

This form must be completed only if you are married but separated and want to establish or modify spousal support. Spousal support can only be established or modified as a FD case when there is no active divorce case.

Pursuant to Court Rule R. 5:5-2 a spousal support modification requires the parties to submit a Case

Information Statement to the court. You must complete the entire form. If something does not apply to you put “n/a”. Do not leave any blank spaces. This completed form must be included in your packet

submitted to the court. This form will be shared with the other party. The other party must complete this same form, file it with the court and send a copy to you. The court will provide instructions to the other party about sharing this information with the filing party prior to the court hearing. This document

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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is confidential pursuant to court rule R. 1:38-3 and is not available for review by any other people besides the two parties involved in the case, their attorneys, and the court.

Certification of Paternity

This form must be completed if you are the unmarried biological mother of a child and you are seeking to establish paternity or child support for the first time and legal paternity of the father that has not been established by a Certificate of Parentage (COP) or a previous court order. This form must also be completed by the biological father filing for legal paternity or the legal caretaker of the child who wants child support, but the legal father has not been identified by the court. Only answer the questions you have personal knowledge about. Put “n/a” if the questions don’t apply to you. This form will be shared with the alleged biological father/mother when they receive the notice to appear.

Form for additional information for the Court to consider (included in this kit)

Use this form if you need additional space to explain to the court what you want the court to consider or your position on a particular issue stated in the complaint. Type or write legibly and be as specific as possible.

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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Court Terms Used in FD Cases

Arrears: Arrears are unpaid or overdue child support, alimony, or spousal support payments.

Application: An application is a written request in which you ask the court to issue an order or to change an order that has already been issued.

Bench Warrant: A bench warrant is an order from the court giving legal authority to law enforcement to arrest a person for failure to appear for a court hearing or failure to comply with a court order.

Certification: A certification is a written statement made to the court when you file papers with the court, swearing that the information contained in the filed papers is true.

Child Support Number (also referred to as “CS Number”): The Child Support Number is the identifying number assigned to your child, spousal, or alimony support case.

Complaint: A complaint is a formal document filed in court that starts a case. It typically includes the names of the parties and the issues you are asking the court to decide.

Court Order: A court order is the written decision issued by a court of law. For example, a child support court order sets forth how often, how much, and what kind of support is to be paid.

Docket Number: The docket number is the identifying number assigned to every case filed in the court.

Exhibits: Exhibits are written documents you provide to the court to support what you want the court to decide.

FD: The letters the court uses to indentify a Non-dissolution case that involves parents who are not legally married or other adults filing for court relief on behalf of minor children. FD also includes married people who separate but need financial support.

File: To file means to give the appropriate forms to the court to begin the court’s consideration of your request

Income Withholding/Wage Garnishment: Income Withholding/Wage Garnishment is a process where automatic deductions are made from wages or other income to pay your support obligation. Income withholding has been mandatory since the enactment of the Family Support Act of 1988.

New Jersey Child Support Guidelines: Both parents are responsible for the financial and emotional support of their children. New Jersey has developed a standard method for calculating child support based on the income of both parents and other factors. The full set of NJ Child Support Guidelines is contained in Rule 5:6A of the New Jersey Court Rules.

NJKiDS (New Jersey Kids Deserve Support): NJKiDS is the New Jersey Child Support automated computer system that tracks child support accounts.

Obligor/Payor: An obligor/payor is the person ordered by the court to pay support, also known as the non-custodial parent (NCP).

Obligee/Payee: An obligee/payee is the person, agency, or institution who receives support, also known as the custodial parent (CP).

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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Party: A party is a person, business, or governmental agency involved in a court action.

Petitioner: Petitioner is another name for the person starting the court action by filing the appropriate papers the court will consider.

Respondent: Respondent is another name for the person who is named as the other party in the court action filed by the petitioner. This person can answer the petitioner by filing a cross application or written response with the court.

Relief: To ask for relief is to ask the court to grant something such as custody, parenting time, or support.

Support Obligation: Support Obligation is the amount of support that the court orders the obligor to pay. The court order includes how much and how often support has to be paid (i.e., per week, per month, bi-weekly, etc.).

Support Enforcement: The Probation Division is required to enforce court orders that call for the payment of child support, health care coverage, and/or spousal support/alimony. If support is not being paid timely, Probation Support Enforcement has many state and federal tools available to enforce child support orders. These can include, but are not limited to:

Income withholding

Court hearing

Bench warrant

Tax offset – federal and state

Judgment (liens attached to property & assets)

Credit bureau notification

Financial Institution Data Match (FIDM) – seizure of bank accounts

Child Support Lien Network (CSLN) – seizure of proceeds from law suits

Passport denial

License suspension

Lottery interception

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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Instructions for Completing the Application / Cross Application

to Modify a Court Order

IMPORTANT NOTICE: Look over the entire form and check only the reliefs you are seeking. You may seek more than one relief, but only the ones you check will be considered on the day of your hearing.

A.Copy the case title exactly as it appears in the original case you are filing about. You can find the correct case title at the top of your last court order.

B.Type or print the names of the parties in the correct order on the “Plaintiff” and “Defendant” lines.

C.Type or print the county in which you are filing the application.

D.Type or print the docket# that has been issued in your case. You can find that number on the previous court order you received.

E.Type or print the CS# that has been issued in your case. You can find that number on the previous court order you received.

F.Type or print your name on the line that says “I”. This tells the court who is filing the application to modify the existing court order.

G.Check whether you are the plaintiff or defendant filing this application.

H.Put the plaintiff’s address on the lines provided. Don’t forget the apartment# or floor if it applies.

I.Put the defendant’s address on the lines provided. Don’t forget the apartment# or floor if it applies.

J.List all of the children who are listed on the support order requesting to be changed. Do not list children that are not supported by the order you want changed.

K.List other interested parties that should be noticed to appear in court if it applies to your case.

1.If you want to change an existing child or spousal support order, fill in the amount of money the court ordered you to pay or are receiving and the how it is paid (weekly, bi monthly, etc.)

a.Child support (first line)

b.Spousal support (second line)

If you are receiving the money put your name on the line “Name of the person receiving spousal support” and DOB.

Check the right box for what you are seeking. Increase/decrease in child support or Increase/decrease in spousal support.

Check the right box if you want to terminate your child support order.

Check the right box that describes your reason child support should be terminated

Check the right box that applies to your reason if you are opposed to the application to terminate child support.

Check the right box if you want to change the way you receive your money. It will be changed from direct payment to you to payment through Probation.

Check the right box if you want the court to end its involvement in the way you receive your support money. In the future, support payments will be made directly between you and the other

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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person. There will be no automatic enforcement activities if the person does not pay.

2.Enforcement of a Support Order

Check this box if you are requesting enforcement of a current support order because someone is not paying as they have been ordered.

Check this box if you have already requested enforcement of your child support order through Probation.

Note: If your child support order is payable through Probation, you should go there first for enforcement.

3.Order Change of existing Custody/Parenting Time Court Order

Check this box if you wish to change the custody or parenting time arrangements in the current order. Write in your own words why you want to change the order in the space provided.

4.Request to Relocate the Children/Opposition to Relocation

Check the right box if you are applying to relocate the children out-of-state. Put in where you want to move and the reason you want to move.

Check the right box if you are opposed to the children moving out-of-state and explain why you are opposed in the space provided.

5.Request to have a Bench Warrant/Detainer Lifted

Check this box only if you are incarcerated and you want a detainer or bench warrant lifted so that you may apply for a work release or half way house program. You must provide the name of the facility where you are now and your inmate #.

6.The relief I am seeking is not listed above.

If the relief you are seeking is not contained in any of the numbered items in the form, write in your own words the relief you are seeking for the court. Be as specific as possible.

7.What else does the court need to know?

In this space write whatever you feel the court should know to support your request. Write the date of the court order you want changed; if you have it, make a copy and attached to the application.

Court Appearance: Read the information carefully. Your appearance is mandatory even if you have an attorney. You may file a written response to this application if you are the non moving party. It must be filed with the court and served on the filing party at least 15 days prior to your hearing date. It must not exceed the page numbers listed.

Check the correct box regarding your knowledge of DYFS involvement with the children.

Check the correct box about your knowledge regarding the children and public assistance.

Check this box only if you are currently incarcerated and you are filing to have your appearance waived.

Read the certification and sign and date the application. Check the correct box as the plaintiff or defendant.

Mail or deliver the application to the correct court house.

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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Plaintiff

vs.

Defendant

SUPERIOR COURT OF NEW JERSEY CHANCERY DIVISION - FAMILY PART COUNTY:

DOCKET NO.: FD -

CS NO:

CIVIL ACTION

Application for Modification

of Court Order

I,

 

of full age, hereby certify the following in support of

this Application/Cross Application to modify the court order of

.

 

 

 

date (if known)

 

I am the

Plaintiff

Plaintiff resides at:

Address:

 

 

City/Town

 

 

County

Defendant resides at:

Address:

 

 

City/Town

 

 

County

Child

Child

Child

Child

Defendant in the above-captioned matter.

State

 

Zip Code

State

 

Zip Code

DOB

DOB

DOB

DOB

Other interested parties’ name(s) and address(es):

1.Establish or Change to an Existing Child/Spousal Support Order (Note: Continue only if you have an established FD Order.)

The current Child Support Court Order is: $

per __________________

 

 

 

 

 

 

 

 

 

(Weekly, bi-monthly, etc.)

 

 

 

The current Spousal Support Court Order is $

 

per

for support of:

 

 

 

 

 

 

(Weekly, bi-monthly, etc.)

 

 

 

Name of person receiving spousal support:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOB

 

 

 

 

 

 

 

 

 

 

 

Form Promulgated by Supplement to Directive #08-11 (11/18/2011), CN 11487 (Application for Modification of Court Order -

Non-Dissolution Docket)

 

 

 

 

 

 

 

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

 

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I am seeking an increase

decrease in child support payments.

Pursuant to R. 5:5-3, you are required to complete a Financial Statement for Summary Support Actions to serve on the other party, and supply the court with either your most recent Federal income tax return, and your three most recent pay stubs at the hearing.

Reason for seeking the change in child support__________________________________________________

_____________________________________________________________________________________

I am seeking an increase

decrease in spousal support payments.

Pursuant to R. 5:5-2, you must complete, supply the court and other party, with a Case Information

Statement ten (10) days before the hearing.

Reason for seeking the change in spousal support________________________________________________

________________________________________________________________________________________

I am requesting the Court to

terminate

not terminate child support for:

Name

 

 

 

 

 

DOB

My child turned 18 years of age on

 

 

.

 

To the best of my knowledge, my child is not physically or mentally disabled.

My child is disabled. Describe disability:

My child is not attending high school or any other special education programs.

My child is attending high school or special program. Provide the name of school and most recent date(s) attended:

My child is not married.

 

If married, date of marriage:

.

My child is not attending college or any other post-secondary education programs.

My child is attending college or a post-secondary education program. Provide the name of the school and most recent date(s) attended:

My child is not in the military.

 

 

 

 

 

If in the military, date enrolled

 

and branch

 

 

.

I am requesting that child/spousal support be made payable through the Probation Division.

 

 

I am requesting that child/spousal support be paid directly to me without court involvement.

 

 

 

 

 

 

 

Form Promulgated by Supplement to Directive #08-11 (11/18/2011), CN 11487 (Application for Modification of Court Order -

 

 

Non-Dissolution Docket)

 

 

 

 

 

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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2.Enforcement of the Current Support Order (check all that apply)

I am requesting enforcement of the current support court order of

 

. Attach a copy of

 

date (if known)

the order you want enforced.

I have already requested enforcement through Probation.

3. Establish or Change of Existing Custody/Parenting Time Court Order

I am requesting to change the custody/parenting time terms of the current court order. Explain the changes you are requesting.

4. Request To Relocate The Child(ren)/Opposition To Relocation

I am applying to relocate the child(ren) listed above. I believe this move is in the best interest of the

child(ren). I want to relocate the child(ren) by

.

New location:

date

 

 

 

 

 

 

Reason for relocation:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attached is the additional information form.

I am opposed to the relocation of the children listed above. I believe this move is not in the best interest of the child(ren). Explain:

Attached is the additional information form.

Form Promulgated by Supplement to Directive #08-11 (11/18/2011), CN 11487 (Application for Modification of Court Order -

 

Non-Dissolution Docket)

 

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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5. Request to have a Bench Warrant/Detainer lifted (Incarcerated Defendants Only)

I am currently incarcerated making application to have a child support bench warrant/detainer lifted so that I may participate in a rehabilitation program. I understand that I must report to the court 30 days after my release.

Facility

 

Inmate #

6. The relief I am seeking is not listed above.

I am seeking the following from the court:

7. What else does the court need to know pertaining to this Application or Cross Application to

 

modify the court order of

 

?

 

 

 

date (if known)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form Promulgated by Supplement to Directive #08-11 (11/18/2011), CN 11487 (Application for Modification of Court Order -

 

Non-Dissolution Docket)

 

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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Court Appearance Information

PLEASE TAKE NOTICE a hearing will be held, in the Superior Court of New Jersey, Family Part, COUNTY, based upon the attached Application and Certification, to modify an

order previously issued by the court.

Your appearance is mandatory. You may bring an attorney, although an attorney is not required. If you require assistance in selecting an attorney, you may contact your County Bar Association. If you cannot afford an attorney, you may contact Legal Services of New Jersey at www.lsnj.org. You may file a written response by certification opposing this application/cross application. Any written response you send to the Court must be sent to the other party. Your written response must be filed with the court and served on the other party at least 15 days prior to the hearing date. If you fail to appear, an Order granting the relief requested by the filing party may be granted although your written response, if filed, will be considered. If you are the filer of this application you may file a certification in support of your application which shall not exceed fifteen (15) pages. If you are the person served with this application to modify, you may file a certification in opposition or a certification in support of a cross application which shall not exceed twenty-five (25) pages. Any further written responses to the above filed certifications shall not exceed ten (10) pages. Forms are available at njcourts.com.

To my knowledge, DCP&P (DYFS)

is

is not actively involved with the child(ren).

To my knowledge, the family

is

is not

receiving public assistance.

I am presently incarcerated and would like to appear; however I understand that unless a judge orders my appearance through a court order to the facility of my incarceration, my request will be decided on the papers that I filed.

I/We certify that all the statements made above are true. I am aware that if any of the statements made by me/us are willfully false, I/we am subject to punishment.

Date

 

 

Signature

 

 

 

 

 

Plaintiff

Defendant

 

 

 

 

Plaintiff / Cross Applicant

Defendant / Cross Applicant

 

 

 

 

 

 

Date

 

Signature

 

 

 

 

 

Co-Plaintiff

Co-Defendant

 

 

 

 

Co-Plaintiff / Co-Cross Applicant

Co-Defendant / Co-Cross Applicant

Form Promulgated by Supplement to Directive #08-11 (11/18/2011), CN 11487 (Application for Modification of Court Order -

 

Non-Dissolution Docket)

 

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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Additional Information Sheet

(Use this sheet to tell the court what else you want the court to know about your reason for your application.)

Full Name:

 

Date:

 

 

 

 

 

 

 

 

 

 

I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment

Date

 

Signature Plaintiff/Counterclaimant

Form Published 09/2011, CN: 11532 (Family Additional Information Sheet)

 

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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New Jersey Judiciary

Confidential Litigant Information Sheet (R. 5:4-2(g))

To assure accuracy of court records - To be filled out by Plaintiff, or Defendant, or Attorney

Collection of the following information is pursuant to N.J.S.A. 2A:17-56.60 and R. 5:7-4.

Confidentiality of this information must be maintained

Please complete the entire form, leaving no blank spaces. If something does not apply to you, enter “N/A”. This form is confidential and will not be shared with the other party.

Docket Number:

CS Number:

Do you have an active Domestic Violence Order with the other party in this case?

Yes

No

 

 

 

 

 

Plaintiff

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Defendant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name (last, first, middle initial)

 

 

 

 

 

 

 

 

 

Name (last, first, middle initial)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social Security Number

Date of Birth

 

Place of Birth

 

 

 

 

 

Social Security Number

Date of Birth

 

Place of Birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address: Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address: Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

State

Zip

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

State

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plaintiff Telephone Number

 

 

 

Employer Telephone Number

 

Defendant Telephone Number

 

 

 

Employer Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Name (or other income source)

 

 

 

 

 

 

 

 

 

Employer Name (or other income source)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Address: Street

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Address: Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

State

Zip

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

State

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Professional, Occupational, Recreational Licenses

 

 

 

 

 

Professional, Occupational, Recreational Licenses

 

 

 

 

(include types and license numbers)

 

 

 

 

 

 

 

 

 

 

 

 

 

(include types and license numbers)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver's License Number

 

 

 

 

State of Issuance

 

 

 

 

 

Driver's License Number

 

 

 

 

 

 

 

State of Issuance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sex

Race/Ethnicity

 

 

 

Height

 

Weight

Eyes

Hair

 

Sex

 

 

Race/Ethnicity

 

 

 

 

 

Height

Weight

Eyes

Hair

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Auto: License Plate

State

 

Make

 

 

Model

 

Year

 

Auto: License Plate

State

Make

 

Model

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attorney Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attorney Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attorney Address: Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attorney Address: Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

State

Zip

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

State

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Children Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social Security

 

 

 

 

 

 

Name (last, first, middle initial)

 

 

 

 

 

 

Date of Birth

Race

 

Sex

 

Number

 

 

Place of Birth

1.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Health Coverage for Children - available through parent filling out this form (

Health Care Provider:

 

Policy Number:

Health Care Provider:

 

Policy Number:

Health Care Provider:

 

Policy Number:

Plaintiff / Defendant)

Group Number:

Group Number:

Group Number:

I certify that the foregoing statements made by me are true to the best of my knowledge. I am aware that if any of the foregoing statements made by me are wilfully false, I am subject to punishment.

Date

Signature

 

 

Form 5 HYLVHG /201 , CN: 1

(& RQILGHQWLDO/LWLJDQW,QIRUPDWLRQ Sheet)

Kit Revised: 02/01/2013, CN 11487 (How to File an FD Application/Cross Application to Modify a Court Order)

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