Form CSX203 "Affidavit in Support of Motion to Modify Child Support" - Minnesota (English/Hmong)

What Is Form CSX203?

This is a legal form that was released by the Minnesota District Courts - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2011;
  • The latest edition provided by the Minnesota District Courts;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form CSX203 by clicking the link below or browse more documents and templates provided by the Minnesota District Courts.

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Download Form CSX203 "Affidavit in Support of Motion to Modify Child Support" - Minnesota (English/Hmong)

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THIS FORM MUST BE COMPLETED IN ENGLISH
(YUAV TSUM TEB TSAB NTAWV NO UA LUS ASKIV)
State of Minnesota
District Court
Xeev Minnesota
Cheeb Tsam Tsev Hais Plaub
County of
Judicial District:
Cheeb Nroog ntawm
Txhooj Hais Plaub
Court File Number:
Zauv Cim Rooj Plaub
Case Type:
Hom Plaub Ntug
In Re the Marriage of:
Qhov Kev Sib Yuav ntawm:
Petitioner
Tus Neeg Foob
Affidavit in Support of Motion
to Modify Child Support
And
thiab
Tsab Ntawv Pov Thawj Txhawb Kev
Thov Hloov Nyiaj Yug Noj Yug Haus
Respondent
Me Nyuam
Tus Neeg Raug Foob
Intervenor
Tus Kws Cuam Tshuam
STATE OF MINNESOTA
)
COUNTY OF _____________________ ) SS
(County where Affidavit Signed)
XEEV MINNESOTA
CHEEB NROOG NTAWM ______________ )SS
(Lub Cheeb Nroog uas Kos Npe Rau Tsab Ntawv Pov Thawj)
I state, under oath, that the following information is true and correct to the best of my knowledge.
Kuv tsa tes rau lub ntuj lees tias cov ncauj cus nram no yeej muaj tseeg thiab yog raws li kuv
muaj rab peev xwm paub tau.
1.My name is__________________________________. In this case, I am the
 Obligor (paying child support)
 Obligee (receiving child support)
Kuv lub npe yog _____________. Hauv rooj plaub no kuv yog
Tus Neeg Them Nyiaj (them nyiaj yug noj yug haus me nyuam)
Tus Txais Nyiaj Them (tau cov nyiaj yug noj yug haus me nyuam)
CSX203
State Hmong
Rev 11/11
www.mncourts.gov/forms
Page 1 of 14
THIS FORM MUST BE COMPLETED IN ENGLISH
(YUAV TSUM TEB TSAB NTAWV NO UA LUS ASKIV)
State of Minnesota
District Court
Xeev Minnesota
Cheeb Tsam Tsev Hais Plaub
County of
Judicial District:
Cheeb Nroog ntawm
Txhooj Hais Plaub
Court File Number:
Zauv Cim Rooj Plaub
Case Type:
Hom Plaub Ntug
In Re the Marriage of:
Qhov Kev Sib Yuav ntawm:
Petitioner
Tus Neeg Foob
Affidavit in Support of Motion
to Modify Child Support
And
thiab
Tsab Ntawv Pov Thawj Txhawb Kev
Thov Hloov Nyiaj Yug Noj Yug Haus
Respondent
Me Nyuam
Tus Neeg Raug Foob
Intervenor
Tus Kws Cuam Tshuam
STATE OF MINNESOTA
)
COUNTY OF _____________________ ) SS
(County where Affidavit Signed)
XEEV MINNESOTA
CHEEB NROOG NTAWM ______________ )SS
(Lub Cheeb Nroog uas Kos Npe Rau Tsab Ntawv Pov Thawj)
I state, under oath, that the following information is true and correct to the best of my knowledge.
Kuv tsa tes rau lub ntuj lees tias cov ncauj cus nram no yeej muaj tseeg thiab yog raws li kuv
muaj rab peev xwm paub tau.
1.My name is__________________________________. In this case, I am the
 Obligor (paying child support)
 Obligee (receiving child support)
Kuv lub npe yog _____________. Hauv rooj plaub no kuv yog
Tus Neeg Them Nyiaj (them nyiaj yug noj yug haus me nyuam)
Tus Txais Nyiaj Them (tau cov nyiaj yug noj yug haus me nyuam)
CSX203
State Hmong
Rev 11/11
www.mncourts.gov/forms
Page 1 of 14
THIS FORM MUST BE COMPLETED IN ENGLISH
(YUAV TSUM TEB TSAB NTAWV NO UA LUS ASKIV)
2. In this case, child support is for:
Hauv rooj plaub no, qhov nyiaj yug noj yug haus me nyuam yog rau:
Child’s Name
Date of Birth
Is there court -ordered parenting time?
Me Nyuam Npe
Hnub Yug
Tsev hais plaub puas ntswj kom muaj sij
hawm saib me nyuam?
 Yes
 No
Muaj
Tsis Muaj
 Yes
 No
Muaj
Tsis Muaj
 Yes
 No
Muaj
Tsis Muaj
 Yes
 No
Muaj
Tsis Muaj
 Yes
 No
Muaj
Tsis Muaj
 Yes
 No
Muaj
Tsis Muaj
 Yes
 No
Muaj
Tsis Muaj
 Yes
 No
Muaj
Tsis Muaj
(Attach a page if more space is needed)
(Rhais ib nplooj ntawv ntxiv yog xav tau chaw sau ntxiv)
If you and the other parent have any other minor children together who are not part of this court
case, write the children’s names and dates of birth here:
Yog koj thiab tus niam txiv tog tod muaj lwm cov me nyuam me ua ke uas tsis txuam nrog rooj
plaub no, sau cov me nyuam npe thiab hnub yug rau ntawm no:
Is there a support case open for any of these children?  Yes
 No
Puas muaj cov rooj plaub sib hais txog nyiaj yug noj yug haus rau cov me nyuam no? Muaj
Tsis Muaj
3. I ask the court to modify the current child support order. I will provide proof that there has
been a substantial change in finances or other circumstances since the last court order. I request
a change in the current basic support order because of: (check all that apply)
Kuv thov lub tsev hais plaub kom hloov qhov nyiaj yug noj yug haus me nyuam lub sij hawm no.
Kuv yuav muab pov thawj kev hloov loj ntawm nyiaj txiag los yog lwm cov xwm txheej txij li
thaum tsev hais plaub ntswj tag los. Kuv thov kom hloov cov kev yug noj yug haus vim yog:
(kos txhua yam muaj feem xyuam)
Substantial change in gross income for  me  other party
Nyiaj hli hloov ntau heev rau
kuv
tog neeg tod
Substantial change in needs for  me  other party  children in this case
CSX203
State Hmong
Rev 11/11
www.mncourts.gov/forms
Page 2 of 14
THIS FORM MUST BE COMPLETED IN ENGLISH
(YUAV TSUM TEB TSAB NTAWV NO UA LUS ASKIV)
Kev tu ncua/nuj nqis hloov loj heev rau
kuv
tog neeg tod
cov me nyuam
hauv rooj plaub
Change in receipt of public assistance for  me
 other party
Nyiaj pab los ntawm tsoom fwv hloov rau
kuv tog neeg tod
Substantial change in cost-of-living for  me  other party
Nqi noj haus hloov ntau heev rau
kuv tog neeg tod
New, extraordinary medical or dental expenses for the child(ren) in this case
Cov me nyuam hauv rooj plaub no muaj nuj nqis tshiab ntau heev
Change in receipt of social security benefits for  me  other party  child
Cov nyiaj laus tuaj hloov rau
kuv tog neeg tod tus me nyuam
Change in the residence of the child(ren)
Tus (Cov) me nyuam chaw nyob hloov.
Emancipation of a child (name of child):
Kev ywj siab ntawm tus me nyuam:
4.
I make the following other comments in support of my request for a change to the
existing basic support order: (Explain the items you checked at #3. For example, why
have living expenses gone up or down? Attach documents or bills that help to prove what
you are saying.)
Kuv teev cov lus nram no txhawb kuv cov lus thov hloov qhov nyiaj yug noj yug haus uas
muaj tam sim no: (Piav qhia cov koj kos rau ntawm nqe 3. Piv txwv, vim li cas nqi noj nqi
haus tias li nce los yog poob? Rhais cov ntaub ntawv los yog ntawv nqi uas yuav ua pov
thawj rau koj cov lus.)
______________________________________________________________________
If you need more space, attach a sheet of paper.
Yog koj xav tau chaw sau ntxiv, rhais ib nplooj ntawv nrog.
5.
I ask the court to change the current order for health care support for the children:
 Yes  No If no, skip to #6.
Kuv thov kom lub tsev hais plaub hloov txoj kev ntswj kom muaj kev pov hwm them
nqi kho mob rau cov me nyuam: Yog Tsis Yog Yog tias tsis yog, hla mus rau nqe 6.
a) Currently, the child(ren) have health care coverage as follows:
Tam sim no, tus (cov) me nyuam muaj kev pov hwm them nqi kho mob raws li nram no:
 Minnesota Care or Medical Assistance
Kev Them Nqi Kho Mob Minnesota Care los yog Kev Pab Them Nqi Kho Mob Medical
Assistance
 No coverage
Tsis muaj kev pov hwm
 I provide coverage
Kuv muas kev pov hwm
 Other parent provides coverage
CSX203
State Hmong
Rev 11/11
www.mncourts.gov/forms
Page 3 of 14
THIS FORM MUST BE COMPLETED IN ENGLISH
(YUAV TSUM TEB TSAB NTAWV NO UA LUS ASKIV)
Tog niam txiv tod muas kev pov hwm
 Other:
Lwm yam:
b) I want to change the way health care coverage is provided for the child(ren). (Explain
what you want changed, and why)
Kuv xav hloov txoj kev tus (cov) me nyuam tau kev pov hwm them nqi kho mob. (Piav
qhia seb koj xav hloov dab tsi thiab yog vim li cas)
c) Health care coverage is available for the child(ren) through my work or union:
YES NO If Yes, answer the following:
Kuv qhov chaw ua hauj lwm los yog lub koom haum muaj kev pov hwm them nqi kho
mob pab rau tus (cov) me nyuam:
YOG
TSIS YOG Yog tias Yog, teb cov lus nram no:
i.
Cost of monthly health care coverage for self: $
Nqi muas kev pov hwm them nqi kho mob rau tus kheej ib hlis twg yog:
ii.
Cost of monthly health care coverage for dependents: $
Nqi muas kev pov hwm them nqi kho mob rau cov me nyuam ib hlis twg
yog:
iii.
Cost of monthly dental insurance for self (if separate coverage from health
care coverage): $
Nqi muas kev pov hwm them nqi kho hniav rau tus kheej ib hlis twg (yog
txawv ntawm kev them nqi kho mob) yog:
iv.
Cost of monthly dental insurance for dependents (if separate coverage
from health care coverage): $
Nqi muas kev pov hwm them nqi kho hniav rau cov me nyuam ib hlis twg
(yog txawv ntawm kev them nqi kho mob) yog:
If coverage is not available through your work, have you checked on the cost of buying
private insurance to cover the health needs of the child(ren)? YES NO
If yes, what is the cost? $_______________________per month.
Yog koj qhov chaw hauj lwm tsis muaj kev pov hwm rau koj, koj puas tau tshawb seb nqi
muas kev pov hwm them nqi kho mob rau tus (cov) me nyuam raug li cas? TAU
TSIS TAU
Yog tau, qhov nqi yog li cas? $ ____ ib hlis twg.
6.
I ask the court to change the court order for Child Care/Day Care Obligation:
 Yes
 No If no, skip to #7.
Kuv thov lub tsev hais plaub hloov txoj Kev Them Nqi Zov Me Nyuam/Chaw Zov Me
CSX203
State Hmong
Rev 11/11
www.mncourts.gov/forms
Page 4 of 14
THIS FORM MUST BE COMPLETED IN ENGLISH
(YUAV TSUM TEB TSAB NTAWV NO UA LUS ASKIV)
Nyuam:
Yog
Tsis Yog
Yog tias tsis yog, hla mus rau nqe 7.
a) I am asking for a new order regarding child care/day care expenses because:
Kuv thov kom muaj ntawv ntswj cov nqi zov me nyuam/chaw zov me nyuam vim:
 There is no court ordered child care obligation and I have child care expenses.
Tsev hais plaub tsis tau ntswj kom them nqi zov me nyuam thiab kuv yeej muaj cov
nqi them zov me nyuam.
 The cost of child care has changed. It has  increased  decreased.
Qhov nqi zov me nyuam hloov lawm. Nws
nce lawm
nqis lawm.
 County assistance with child care expenses has changed.
Cheeb nroog kev pab them nqi zov me nyuam tau hloov lawm.
b) I need a change in the child care support order because: (Use this space to explain
what has changed and how that impacts the costs)
Kuv xav kom hloov qhov nyiaj yug noj yug haus rau me nyuam vim: (Siv qhov chaw
no sau piav yam hloov lawm thiab seb nws tshuam nrog cov nqi li cas)
c) The current total monthly costs of child care are $
Qhov nqi zov me nyuam ib hlis twg tam sim no yog
d) If there is an existing court order for monthly child care expenses, state the court-
ordered amount: $
Yog tsev hais plaub yeej ntswj kom them nqi zov me nyuam lawm, teev qhov nqi uas tsev
hais plaub tau ntswj kom them:
Look at your current Child Support Order to answer the next questions. If you do not have your
Order, contact Court Administration or go to the courthouse to get a copy. You need to prove
that your circumstances today are significantly different than they were at the time of the last
order, and that the changes make the current order unfair.
Saib ntawm koj Tsab Ntawv Ntswj Nyiaj Yug Noj Yug Haus Me Nyuam los teb rau cov nqe lus
nug nram no. Yog koj tsis muaj koj Tsab Ntawv Ntswj, hu rau Tus Neeg Lis Dej Num Hauv
Tsev Hais Plaub los yog mus luam ib tsab hauv tsev hais plaub. Koj yuav tau muaj pov thawj
qhia tias hnub no koj cov xwm txheej hloov loj heev tshaj thaum ua tsab ntawv ntswj, thiab cov
kev hloov ua muaj kev tsis ncaj ncees tam sim no.
7.
The existing support order was issued by the court in ________________County and is
dated ___________________________.
Lub tsev hais plaub uas muab tsab ntawv ntswj nyiaj yug noj yug haus tam sim no yog
hauv lub Cheeb Nroog ______ thiab muab thaum ______.
8.
At the time the existing order was issued I was:
CSX203
State Hmong
Rev 11/11
www.mncourts.gov/forms
Page 5 of 14