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Here is the text we could read:

 

 

 
Name 

 
Address 

 
Phone 

 
Email 

 
City, State, Zip 

 
 
 
 
 
 
 
 
 

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the Matter of (select one) 
 

[  ]  the Marriage of (for a divorce with or without 
children, annulment, separate maintenance, or 
temporary separation case) 

[  ]  the Children of (to establish custody, parent-

time or child support) 

[  ]  the Parentage of the Children of (for a 

paternity case) 

____________________________________ 
(name of Petitioner) 

and  

 

____________________________________ 
(name of Respondent) 
____________________________________________ 
Other parties (if any) 

Order on Motion to Adjust Child 
Support 
(Utah Rule of Civil Procedure 106 and Utah 
Code Section 78B-12-210(8)) 

_______________________________ 
Case Number 

_______________________________ 
Judge 

_______________________________ 
Commissioner 

The matter before the court is a Motion to Adjust Child Support. This matter is being 
resolved by: (Choose all that apply.) 

[  ]  The default of     [  ] petitioner     [  ] respondent. 

[  ]  The stipulation of the parties. 

[  ]  The pleadings and other papers of the parties. 

[  ]  A hearing held on __________________________ (date), notice of which was 

served on all parties. 

1139FAJ Approved January 27, 2020 / 
Revised May 1, 2022 
 

Order on Motion to Adjust Child Support 

Page 1 of 7 

 

[  ]  was represented by _______________________ 

Petitioner 

[  ]  was   [  ] was not present  

[  ]  was not represented. 

Respondent 

[  ]   was   [  ] was not present  

 

 

[  ]   was represented by _______________________ 

[  ]   was not represented. 

The court finds: 

1. 

The order controlling child support is: 

Title of order: 

Name of Court: 

Address of 
Clerk of Court: 

Case Number: 

Date Signed: 

 

 

 

 

 

 

 

 

 

 

State 
Phone Number 
of Clerk of 
Court: 

Case Name 

Signed by 
Judge: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. 

There are ________ (number) minor children included in the controlling order.  

Child’s name 
(first, middle and last) 

Child’s 
gender 

Month and year 
of birth 

3. 

4. 

Utah [  ]  does    [  ]  does not have jurisdiction in this case.  

The order has not been modified within the last three years, and 

• 

there is a difference of 10% or more between the support amount as 
ordered and the support amount as required under the guidelines; and 

1139FAJ Approved January 27, 2020 / 
Revised May 1, 2022 
 

Order on Motion to Adjust Child Support 

Page 2 of 7 

 

the difference is not temporary; and 

• 

• 

the proposed support amount is consistent with the child support 
guidelines.  

5. 

[  ]  Child support 

a.  Petitioner’s total countable gross monthly income for child support 

purposes is $________________ (Utah Code 78B-12-203).  

[  ]  Petitioner’s income is imputed based on: 

 

[  ] minimum wage. 

[  ] historical earnings. 

[  ]  Petitioner does receive or has received public assistance. 

b.  Respondent’s total countable gross monthly income for child support 

purposes is $________________ (Utah Code 78B-12-203).  

[  ]  Respondent’s income is imputed based on: 

 

[  ] minimum wage. 

[  ] historical earnings. 

[  ]  Respondent does receive or has received public assistance. 

The court  [  ]  does    [  ]  does not    have jurisdiction. 

There  [  ]  are    [  ] are not    grounds to adjusted the controlling order. 

The court concludes:  

[  ]  Other:  

   

The court orders: 

9. 

 

The motion is:   

[  ] denied.  

6. 

7. 

8. 

1139FAJ Approved January 27, 2020 / 
Revised May 1, 2022 
 

Order on Motion to Adjust Child Support 

Page 3 of 7 

 

 

[  ] granted. The controlling order dated ___________ (date) is adjusted as 

follows. 

10. 

[  ]  Child support 

a.  [  ] Petitioner   [  ] Respondent must pay $________________ per month 

for child support. The following child support worksheet is attached (Choose 
one.):  

[  ]  sole physical custody worksheet 

[  ]  joint physical custody worksheet 

[  ]  split custody worksheet 

(Choose one.) 

Code 78B-12-2). 

[  ]  This amount is based on the Uniform Child Support Guidelines (Utah 

[  ]  This amount deviates from the Uniform Child Support Guidelines.  
The court finds that a deviated child support amount is in the best 
interests of the minor children based on: 

[  ]  the standard of living and situation of the parties. 

[  ]  the relative wealth and income of the parties. 

[  ]  the obligor’s (person who pays support) ability to earn. 

[  ]  the ability of the obligee (person who receives support) to earn. 

[  ]  the ability of an incapacitated adult child to earn, or other 

benefits received by the adult child or on the adult child's behalf 
including Supplemental Security Income. 

[  ]  the needs of the obligee, the obligor, and the child. 

[  ]  the responsibilities of the obligor and the obligee for the support 

[  ]  the ages of the parties. 

of others. 

[  ]  other. (Describe.):  

___________________________________________________ 

The reason for the deviated child support amount is:  

_______________________________________________________ 

_______________________________________________________ 

______________________________________________________. 

1139FAJ Approved January 27, 2020 / 
Revised May 1, 2022 
 

Order on Motion to Adjust Child Support 

Page 4 of 7 

 

b.  Effective date (Choose one.): 

[  ]  The child support will be effective upon entry of this order.  

OR 

OR 

[  ]  The child support will be effective as of this date: ________________. 

c.  Child support must be paid as follows (Choose one.): 

[  ]  Mandatory income withholding by the Office of Recovery Services.  
Unless the Office of Recovery Services gives notice that payments 
should be sent elsewhere, all child support payments must be made to:  
Office of Recovery Services, PO Box 45011, Salt Lake City, UT 84145  

[  ]  Direct payments to the parent receiving child support by: 

[  ]  Check 

[  ] Deposit in bank account 

[  ] Cashier’s check or money order 

[  ] Other: ________________________________________________ 

d.  Child support payments must be made (Choose one.): 

[  ]  One-half on or before the 5th day of each month, and one-half on or 

before the 20th day of each month. 

OR 

[  ]  Other payment arrangement: 

________________________________________________________ 

e.  Child support not paid on or before the due date is past due on the day 

after the due date.  

f.  Past-due child support will be determined by further judicial or 

administrative process. Any federal or state tax refund or rebate due to the 
non-custodial parent will be intercepted by the state of Utah and applied to 
child support arrearages. 

11. 

[  ] Attorney fees and costs 

[  ]  Petitioner    [  ]  Respondent  must pay $___________ in attorney fees 
and $___________ in costs. 

12. 

[  ]  Other orders 

1139FAJ Approved January 27, 2020 / 
Revised May 1, 2022 
 

Order on Motion to Adjust Child Support 

Page 5 of 7 

 

13.  Remainder of order unchanged 

The provisions of any previous order not modified by this order remain in effect. 

Commissioner’s or judge’s signature may instead appear at the top of the first page of this document. 

   

 

Signature ► 

Commissioner 

Signature ► 

Judge 

 

 

 

 

 

 

 

 

pproved as to form. 

Signature ► 

Petitioner, Attorney or Licensed Paralegal 
Practitioner 

Signature ► 

Respondent, Attorney or Licensed Paralegal 
Practitioner 

 
Date 

 
Date 

    A

 
Date 

 
Date 

 

1139FAJ Approved January 27, 2020 / 
Revised May 1, 2022 
 

Order on Motion to Adjust Child Support 

Page 6 of 7 

 

 

 

 

Certificate of Service 

I certify that I filed with the court and am serving a copy of this Order on Motion to Adjust Child Support 
on the following people. 

Person’s Name 

Service Method 

Service Address 

Service 
Date 

 

 

 

 

 
Date 

 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email 
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email 
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email  
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

 

 

 

Signature ► 

Printed Name 

 

 

1139FAJ Approved January 27, 2020 / 
Revised May 1, 2022 
 

Order on Motion to Adjust Child Support 

Page 7 of 7

Order on Motion to Adjust Child Support

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from legacy.utcourts.gov (2023-03)
Page(s): 7
Fields(s): 141
Average fields per page: 20
Reading Level: Grade 10
LIST Grouping(s): GO-00-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

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Suggested Screen 0:

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Order on Motion to Adjust Child Support

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02