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Free Virginia Child Custody Form

Forms in Child Custody

Use this template/form to file for child custody in the state of Virginia

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Text version of this Form

———————– Page 1———————–

IN THE FAMILY COURT OF ________________ COUNTY, WEST VIRGINIA.

In Re:

The Marriage / Children of: Civil Action No. ____________

_________________________, and _________________________.

Petitioner Respondent

_________________________ _________________________

_________________________ _________________________

Address Address

________________ ________________

Daytime phone Daytime phone

PETITION FOR MODIFICATION

1. General Information

a. The Petitioner is: ________________________, who is:

(Print your name.)

___ the mother / wife whose name is listed in the case style at the top of this page.

___ the father / husband whose name is listed in the case style at the top of this page.

___ other person, whose relationship to the Respondent / children is: __________________

______________________________________________________________________.

b. The Petitioner requests that the Order entered on the date of ________________________ be

modified with regard to:

___ Parenting Plan

___ Child support

___ Spousal support

___ Other; (Explain) _________________________________________________________

__________________________________________________________________.

=

2. I want the Court to modify the Order in these ways: (Check all that apply.)

___ Increase child support

___ Decrease child support ___ End child support

___ Change Parenting Plan with regard to: ___ Decision making;

___ Time spent with the children; ___ Other; (Explain) ________________________

__________________________________________________________________.

___ Order child support paid to another person, who

SCA-FC-201 (12/01) Petition for Modification Page 1 of 3

———————– Page 2———————–

is:_____________________________.

___ Order child support paid by another person, who

is:_____________________________.

___ Increase spousal support

___ Decrease spousal support ___ End spousal support

___ Other modification request(s); (Explain.) _______________________________________

_______________________________________________________________________

______________________________________________________________________.

=

3. Circumstances that justify the modification I am requesting.

(Explain all of the changes in circumstances you think justify the modifications you requested.) :

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________.

4. Information concerning Public Assistance and Child Support Enforcement Services

a. ___ A Public Assistance check from Health and Human Services is now being received

by: ___ The Children; ___ The Petitioner; ___ The Respondent.

b. ___ A Public Assistance check from Health and Human Services was received in the

past by: ___ The Children; ___ The Petitioner; ___ The Respondent.

c. ___ Services from the Bureau for Child Support Enforcement have been applied for by:

___ The Petitioner; ___ The Respondent.

d. ___ Income withholding services are currently being received from the Bureau for Child

Support Enforcement.

_________________________________ ___________________

Petitioner’s Signature Date

You must sign the Verification on the next page before a Notary Public.

VERIFICATION

I, ____________________________, after making an oath or affirmation to tell the truth, say

that the facts I have stated in this Petition are true of my personal knowledge; and if I have set

forth matters upon information given to me by others, I believe that information to be true.

SCA-FC-201 (12/01) Petition for Modification Page 2 of 3

———————– Page 3———————–

___________________________ ___________________

Signature Date

This Verification was sworn to or affirmed before me on the ____ day of __________________,

2_____.

_________________________

Notary Public / Other official

My commission expires:______________________.

CERTIFICATE OF SERVICE

State of West Virginia

County of _______________________________

I, ____________________________, the Petitioner for Modification, mailed my Petition

by first class United States Mail, postage paid, to:

______________________________________________________________________________

(Name and Address)

________________________________

(Date mailed)

And:

______________________________________________________________________________

(Name and Address)

________________________________

(Date mailed)

___________________________ ____________

Petitioner’s Signature Date

SCA-FC-201 (12/01) Petition for Modification Page 3 of 3


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