In the Tribal Court of The

IN THE TRIBAL COURT OF THE

QUECHAN INDIAN TRIBE

450 Quechan Drive, Winterhaven, CA92283

Petitioner’s Name and Address
______
______/ Respondent’s Name and Address
______
______/ ______Case Number
PETITION FOR
 CHILD SUPPORTAnd/Or
 PATERNITY

I, ______, petitioner hereby avers to the following:

1)The above named Petitioner and Respondent ______,

(Name of Respondent)

 are/  are not married to each other at the commencement of this petition and are living separate and apart.

2)The natural or adopted children under age 18common to the parties are:

NameD.O.B.Enrollment Number

______

3)PETITIONER

D.O.B. ______Enrollment Number ______

SS# ______

Employer: ______

Employer’s Address: ______

______

4)RESPONDENT

D.O.B. ______Enrollment Number ______

SS# ______

Employer: ______

Employer’s Address: ______

______

5)The Quechan Tribal Court has jurisdiction to preside over these matters because:

Quechan Indian Reservation is the domicile of the children common to the parties and the children continue to live on the Quechan Indian Reservation.

The natural or adopted children are enrolled members of the Quechan Indian Tribe.

One or both parties are enrolled members of the Quechan Indian Tribe and Quechan Indian Reservation is the domicile of one or both of the parties at the commencement of this proceeding and one or both parties continues to live on the Quechan Indian Reservation.

6)The court should grant this petition for child support for the following reasons:

______

7)There  are/  are not any pending court procedures in other jurisdictions that could affect the minor child(ren).

8)If there are pending court proceedings in other jurisdictions that could affect the minor child(ren), list:

the court:______type of proceeding ______

court’s address: ______

______

court’s telephone number:______Case No.: ______

Therefore, the petitioner asks this Court to set a hearing in this matter and order the following:

That ______, respondent, pay child support in the amount of $______or that which is determined by the Court (See Child Support Guidelines)

That this payment be by wage assignment payable through the Clerk of the Court’s office.

That this Court determine and establish paternity.

Other requests: ______

The undersigned swears or affirms that the statements set forth above are true, correct, and complete to the best of my knowledge and are subject to penalties of making a false affidavit or declaration.

Date: ______

Petitioner

Subscribed and sworn to before me on this ______day of ______, 20______.

______

My Commission ExpiresNotary Public/Court Clerk

Revised:8/27/2009Page 1 of 3

Form CH3