REQUEST FOR MODIFICATION REVIEW
To request a review of your Court order for child support, you must complete and return an Income and Expense Declaration. A blank Income and Expense Declaration and completed sample is accessible by clicking the following link: Income and Expense Declaration.
Attach your fully completed, signed and dated Income & Expense Declaration to this form, and return the completed forms to us in person at the reception counter, or, mail to:
Department of Child Support Services
County of San Bernardino
10417 Mountain View Ave.
Loma Linda, CA 92354
Please provide the following information to assist us in the review:
NAME: __________________________________________________________________
ADDRESS: __________________________________________________________________
__________________________________________________________________
PHONE: ( ) ( ) ( )___________________
Cell Daytime Evening
E-MAIL: __________________________________________________________________
COURT CASE NO.: __________________________________________________________
What best describes the reason(s) you are requesting a change to your child support order:
My income has changed
The income of the other parent has changed
There has been a change in the amount of time the child(ren) spend with me
OTHER REASON(S): ________________________________________________
________________________________________________________________________
________________________________________________________________________
Date:__________________ __________________________________________
SIGN HERE