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Free Virginia Child Custody Form

SCA-FC-201 or the Virginia Child Custody Form Petition for Modification is a document designed to seek modification from the court in the best favor of the child. The petitioner must provide valid reasons for seeking these modifications and furnish the particulars of the modifications accordingly.

The SCA-FC-201 or the Virginia Child Custody form has three sections, namely the Petition for Modification, Verification, and Certificate of Service. Furnishing truthful information in each section is mandatory. Submit the duly completed SCA-FC-201 form before the Family Court of the concerned county of West Virginia State. You must sign in the Verification section before the Notary Public of West Virginia state. Specify your choices for the modifications in the spaces provided for the same.

Type the name of the county in the space reserved on the first line of form SCA-FC-201. Then proceed by furnishing the Civil Action number and details pertaining to marriage/children of on the following line. Provide the information of the petitioner and the respondent like legal names, addresses, and daytime phone numbers in the respective fields.

Subsection (a) of section 1, General Information seeks the input of the name of the petitioner and the relation to the child. Specify between the choices of the mother or father and furnish the relation if you select other. Subsection (b) requires furnishing the date of the court order under the request for modification followed by the nature of the modification. Select between parenting plan, child support, spousal support, or provide particulars if you select others.

Section 2 of form SCA-FC-201 offers space for requesting the modification. Select all the choices that apply to the petition for modification of the order. Select between increasing, decreasing, or ending the child support; change in the parenting plan with reference to decision-making, time spent, or furnish any other reason in the space provided for the same. Continue with the selection of the mode of payment of child support, select one choice as appropriate, and furnish the name of the person in the space set aside for the same. Enter the choice between increase, decrease, or end spousal support and specify other modification requests if any.

Section 3 has space to highlight the circumstances justifying the request for the modification. Specify these conditions descriptively. Use separate line for describing each circumstance. Furnish the information about the Child Support Enforcement Services and Public Assistance. Select as applicable between the subsections a, b, c, and d and provide your choices by selecting the appropriate submenu. Sign after completion of the selection and insert date in front of the signature.

The next section verification requires your name as a petitioner and signature before a Notary Public. The Notary Public must complete the remaining portion with the seal, signature, and specifying the date of the expiry of the commission. Petitioner must sign the Verification before a Notary Public and it is obligatory.

The concluding section of SCA-FC-201 requires input of the name of the county, petitioner’s name, then the name and address of the respondent, and date of mailing the petition. Furnish details of the second respondent if any, and complete the petition by signing it and inserting date next to the signature.

Virginia Child Custody Form

Text version of this Form

———————– Page 1———————–


In Re:

The Marriage / Children of: Civil Action No. ____________

_________________________, and _________________________.

Petitioner Respondent

_________________________ _________________________

_________________________ _________________________

Address Address

________________ ________________

Daytime phone Daytime phone


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———————–


___ Order child support paid by another person, who


___ 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.


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 __________________,



Notary Public / Other official

My commission expires:______________________.


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)



(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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