Request for Modification, Termination or Credit on Arrears - Change ...

STATE OF OREGON, Child Supp<strong>or</strong>t Program (CSP), by the Administrat<strong>or</strong> (ORS 25.010)County: Court #: CSP #:[ ] Other Jurisdiction: Case #:Children:Oblig<strong>or</strong>:Obligee:[ ] Other parties:Uni<strong>f<strong>or</strong></strong>m Income & Expense StatementContact in<strong>f<strong>or</strong></strong>mation:Cell #: Text? Yes No Message #:Home #:Email:Date Signature Printed NameAddress City State ZipThe address you list above will be your “contact address.” We will use it to send documents to you. It will also appear in legalpapers given to the other parent and in court rec<strong>or</strong>ds. If you do not want your residence <strong>or</strong> mailing address to be given to theother party <strong>or</strong> appear in court rec<strong>or</strong>ds, you must give us a different address in your state <strong>f<strong>or</strong></strong> the CSP to use as your “contactaddress.” If the address you give now is different than one you gave us be<strong>f<strong>or</strong></strong>e, we will use the new one from now on.List all ‘Joint Children’ in this Order (children under the age of 21, b<strong>or</strong>n to <strong>or</strong> adopted by the parties)Name of Child DateChildren Living With:Child 18-20 in If Child 18, inofSchool High SchoolBirthOtherYes No Yes NoMe Parent Other (Name)List your additional joint children on a separate sheet of paper.Do you already have a supp<strong>or</strong>t <strong>or</strong>der <strong>f<strong>or</strong></strong> these children? Yes No If yes, explain and attach themost recent copy of your <strong>or</strong>ders, if available:Do you have a parenting time <strong>or</strong>der <strong>or</strong> written parenting time agreement <strong>f<strong>or</strong></strong> these children? Yes No If yes, attach a copy of the <strong>or</strong>der <strong>or</strong> agreement.Page 1 of 4 - UNIFORM INCOME & EXPENSE STATEMENTCSF 01 0100 (Rev. 04/18/14) CSCM Initials CSP#: