§ Motion to Modify Child Custody
Motion to Modify Child Custody
[Publisher's note: Referenced interactive forms can be accessed at www.selfrepresent.mo.gov]
In what Missouri county was the In the Circuit Court of
judgment you want to modify entered? MISSOURI
What is the case number of the judgment you want
to modify? Case Number Division Number
Answer all questions on this form completely.
Your Information 1. My current full name is:
________________ ________________ ________________ _________
(First Name) (Middle Name) (Last Name) (Jr./Sr./III)
2. [ ] I filed the original case. (Petitioner/Plaintiff)
[ ] I did not file the original case. (Respondent/Defendant)
3. [ ] I am the Mother
[ ] I am the Father
4. The last four numbers of my Social Security Number are: XXX-XX-
____________________________________________________________
5. My mailing address is:
____________________________________________________________
(Street)
__________________________________ _______________ ________
(City) (State) (Zip)
_________________________________ __________________________
(Telephone Number) (E-Mail Address)
Other Party's
Information 6. The current full name of the other party is:
________________ ________________ ________________ _________
(First Name) (Middle Name) (Last Name) (Jr./Sr./III)
7. The last four numbers of the other party's Social Security Number are:
XXX-XX- __________
8. The other party's mailing address is:
____________________________________________________________
(Street)
_________________________________ _______________ ________
(City) (State) (Zip)
_________________________________ __________________________
(Telephone Number) (E-Mail Address)
Motion to Modify Child Custody--Page 1 of 5
Form CAFC101-7/1/ This form is available for free at www.selfrepresent.mo.gov
2010
Service
Information 9. [ ] The other party has signed a verified “Answer to Motion to Modify” which is being filed with
this motion. Therefore, do not issue a summons.
[ ] The other party should be served at his or her residence.
____________________________________________________________
(Street)
______________________ ______________ ______________________
(City) (State) (Zip)
[ ] The other party should be served at his or her place of employment.
____________________________________ _______________________
(Employer's Name--if applicable) (Hours of Employment)
____________________________________________________________
(Street)
______________________ ______________ ______________________
(City) (State) (Zip)
[ ] Service by publication. I don't know where the other party is and I have no way of locating him
or her. Therefore, I am requesting that he or she be served by publication. I have filed an Affidavit
for Service by Publication and a Notice of Publication.
[ ] Other method of service:
____________________________________________________________
10. [ ] The parent receiving support is not receiving Temporary Assistance for Needy Families (TANF).
[ ] The parent receiving support is receiving TANF and therefore the State of Missouri must be
served. Summons to issue to be served on:
Director, Family Support Division
615 Howerton Court
Jefferson City, Missouri 65102
Case 11. The judgment I want to change was entered on
____________________________________________________________.
Information (MM/DD/YYYY)
12. [ ] I was ordered to pay child support to the other party.
[ ] The other party was ordered to pay child support to me.
[ ] We both were ordered to pay child support.
[ ] No child support was ordered by the court.
13. [ ] All child support ordered by the court has been paid.
[ ] All child support ordered by the court has not been paid.
14. The child custody judgment that I want to modify is:
[ ] A dissolution of marriage or legal separation judgment.
[ ] A paternity judgment entered by a court.
[ ] A custody and support judgment entered by a court.
[ ] A judgment modifying a previous dissolution of marriage or legal separation judgment.
[ ] A judgment modifying a previous paternity judgment.
[ ] A judgment modifying a previous custody and judgment.
[ ] Other _________________________________________________________
(Explain)
Motion to Modify Child Custody--Page 2 of 5
Form CAFC101-7/1/ This form is available for free at www.selfrepresent.mo.gov
2010
Military
Information
15. [ ] The other party is NOT on active duty in the United States military.
[ ] The other party is on active duty in the United States military.
16. [ ] I am self-employed
[ ] I am unemployed
Employment
Information
[ ] I am employed at:
____________________________________________________________
(Name of Employer)
____________________________________________________________
(Street)
______________________ ______________ ______________________
(City) (State) (Zip)
17. [ ] The other party is self-employed
[ ] The other party is unemployed
[ ] I don't know the other party's employment status
[ ] The other party is employed at:
____________________________________________________________
(Name of Employer)
____________________________________________________________
(Street)
______________________ ______________ ______________________
(City) (State) (Zip)
Children's 18. There is/are __________ child(ren) who is/are the subject of this proceeding as listed below.
Information
Child's Full Name Child's Age
Motion to Modify Child Custody--Page 3 of 5
Form CAFC101-7/1/
2010
This form is available for free at www.selfrepresent.mo.gov
Changes affecting
Custody
19. What has changed since the last custody judgment that would justify a different custody
arrangement? You may include information that was unknown to the trial court at the time of the
previous judgment pursuant to RSMo. § 452.410
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Additional
Information about
the Children
20. State all addresses at which the children have resided during the past six months and the name of the
person with whom said children resided.
____________________________________________________________
____________________________________________________________
____________________________________________________________
21. Do you know of anyone other than you or the other parent that has physical custody of any of the
children or claims to have custody or visitation rights with respect to any of the children?
[ ] Yes--State the name(s) and address(es) of these people in Paragraph 25.
[ ] No
22. Do you have any information of any other custody proceeding concerning any of the children pending
in a court of this or any other state?
[ ] Yes--Attach a copy of the petition or judgment from all other cases.
[ ] No
23. Have you participated in any other litigation concerning the custody of any of the children in this or
any other state?
[ ] Yes--Attach a copy of the petition or judgment from all other cases.
[ ] No
24. Have any of the child(ren) been a victim of abuse or neglect?
[ ] Yes
[ ] No
25. If you answered “Yes” to questions 21, 22, 23 or 24 please explain.
____________________________________________________________
____________________________________________________________
____________________________________________________________
Motion to Modify Child Custody--Page 4 of 5
Form CAFC101-7/1/
2010
This form is available for free at www.selfrepresent.mo.gov
Proposed
Parenting Plan
26. The custody arrangement that is in the best interests of the minor children is set forth in Part A of the
attached parenting plan marked Exhibit 1. (You must attach a completed copy of Parenting Plan
Form CAFC501 to this motion.)
Request for Relief THEREFORE, I want to change the previous judgment concerning custody as per Part A of the attached
parenting plan marked Exhibit 1.
I also request the following relief:
[ ] Child support should be changed as set forth in Part B of the attached parenting plan marked
Exhibit 2.
[ ] I am without sufficient funds to pay for my attorney and I request that the other party pay my
attorney's fees for this case.
[ ] Other (Please state the other requests)
__________________________________________________________
__________________________________________________________
__________________________________________________________
[ ] Petitioner/Plaintiff [ ] Respondent/Defendant, of lawful age, being duly sworn on his or her oath, states that he or she is the
party named above and that the facts stated in this Motion to Modify Child Custody are true according to his or her best
knowledge and belief.
_____________________________________________ ___________________________
SIGN HERE (Sign this in front of a Notary Public) PRINT YOUR NAME HERE
Subscribed and sworn to this _____ day of __________, 20 ___.
______________________________
Notary Public
My Commission Expires:
______________________________
ATTORNEY INFORMATION (To be completed by your attorney) Do not enter any information here if
you are filing this
___________________________ _____________________ case without the assistance
Attorney--SIGN HERE Missouri Bar Number of a lawyer.
__________________________________________________ This information should be
Attorney for Movant--PRINT YOUR NAME HERE completed by your attorney.
__________________________________________________
(Street)
_______________________________ ___________ _____ [ ] I have assisted the above
(City) (State) (Zip) named party in the preparation
of these pleadings, but I am
________________ ____________ ___________________ not entering my appearance on
(Telephone Number) (Fax Number) (Email Address) his or her behalf.
Motion to Modify Child Custody--Page 5 of 5
Form CAFC101-7/1/
2010
This form is available for free at www.selfrepresent.mo.gov
<[Publisher's note: Referenced interactive forms can be accessed at www.selfrepresent.mo.gov]>