Free Petition - West Virginia

IN THE FAMILY CO URT OF ________________ COUNTY, W EST VIRGINIA Civil Action No. ____________

_____________________. Respondent _____________________ _____________________ _____________________, Petitioner _____________________ _____________________
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* _____________________. Respondent _____________________ _____________________
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PETITION FOR SUPPORT and / or ALLOCATION OF CUSTODIAL RESPONSIBILITY

1.
a. The Petitioner is: ________________________________________.
(Print your name.)

b. The Petitioner currently resides in _____________________ County, West Virginia. c. List the full names, dates of birth, and social security numbers for the children for whom support and / or custodial responsibility is being requested. In the rest of the Petition, "the children" will always mean the children whose names you have listed here.
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Name

Date of Birth

Social Security Number

___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ d. What is the Petitioner's relationship to the children? ________________________________. e. What is the Petitioner's relationship to the Respondent(s) listed above? __________________________________________________________________________ f. What is the Children's relationship to the Respondent(s) listed above? __________________________________________________________________________ g. The first Respondent listed above currently resides: ___ ___ ___ at an address unknown to the Petitioner. in _____________________ County, West Virginia. outside the state of West Virginia, where the last known address was ______________ _____________________________________________________________________. h. The second Respondent listed above currently resides: ___ ___ ___ at an address unknown to the Petitioner. in _____________________ County, West Virginia. outside the state of West Virginia, where the last known address was ______________ _____________________________________________________________________. i. The parents of the children last cohabited together in _____________________ County, in the state of ___________________________, on the date of _______________________. ___ Do not know. j. Are the parents of the children currently expecting another child? ___ Do not know. ___ No ___ Yes If "yes," what is the due date? __________________ k. The children currently reside with: ___ Mother, at this address: _____________________ ______________________________________. ___ Father, at this address: ___________

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_____________________________________________. ___ The Petitioner, at this address: _____________________________________________________. ___ Someone else, whose name, relationship to the children, and address are: _______________________ __________________________________________________________________________. l. During the last five years, if any of the children have lived at addresses other than the address you just listed, list those other addresses below, and list the name and relationship to the children of all adults other than the parents who lived at these addresses with the children. If there is not enough room in the following space, use an additional sheet of paper. I have attached ____ additional sheet(s). ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

2. Check all of the following items that apply.
a. Has the Petitioner been a party or witness in any other proceeding, in any state, concerning the allocation of custodial responsibility for the children? ___ Yes ___ No b. Is the Petitioner aware of any other proceeding, past or present, in any state, concerning allocation of custodial responsibility for the children? ___ Yes ___ No c. Is the Petitioner aware of any other person, other than the parties to this case, who has physical custody of, or claims any custodial right concerning the children? ___ Yes ___ No

3. Check all of the following items that apply.
a. ___ The children have resided in West Virginia for at least 6 months preceding the filing of this case, or from birth, if less than six months old. b. ___ The Petitioner believes it is in the best interest of the children for a West Virginia court

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to assume jurisdiction of this case, because one or both of the parents have a significant connection to West Virginia, and West Virginia is the location of a substantial number of witnesses and / or other sources of evidence relating to the children's current or future care and personal relationships. c. ___ The children are now present in West Virginia, and have been abandoned here. d. ___ The children are now present in West Virginia, and the Petitioner believes it is necessary for a West Virginia court to assume jurisdiction of this case on an emergency basis to protect the children, because the children have been subjected to or threatened with mistreatment or abuse, or have otherwise been neglected, or are depending on persons other than their parents. e. ___ The Petitioner believes no other state has jurisdiction over this case, and it would be in the children's best interest for a West Virginia court to assume jurisdiction. f. ___ Another state has declined to assume jurisdiction over this case on the ground West Virginia is the more appropriate place to decide matters relating to the allocation of custodial responsibility, and for this reason, the Petitioner believes it would be in the children's best interest for a West Virginia court to assume jurisdiction.

4. Check all of the following items that apply.
a. ___ The county in which this case has been filed is the county in which the children currently reside. b. ___ The county in which this case has been filed is the county in which: ___ the first Respondent currently resides; ___ the second Respondent currently resides. c. ___ The county in which this case has been filed is the county in which the Petitioner currently resides, and: ___ the first Respondent is currently a nonresident of West Virginia; ___ the second Respondent is currently a nonresident of West Virginia.

5. Check all of the following items that apply.
a. ___ The Petitioner is 18 or older. ___ The first Respondent is 18 or older. ___ The second Respondent is 18 or older. b. ___ The Petitioner has not been declared legally incompetent. ___ The first Respondent has not been declared legally incompetent. ___ The second Respondent has not been declared legally incompetent. c. ___ The Petitioner is not incarcerated. ___ The first Respondent is not incarcerated. The second Respondent is not incarcerated. ___

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d. ___ The Petitioner is in need of support for the care and upbringing of the children.

6.
Answer item a. ONLY if you are a parent of the children . a. ___ Prior to the parents' separation, both parents performed a reasonable share of the caretaking and parenting functions for the children. For this reason, the Petitioner believes it is appropriate for the parents to continue to share the authority for making significant decisions relating to the children's care and upbringing. The Petitioner also believes custodial responsibility for the children should be allocated in proportion to the time each parent spent in caretaking and parenting functions before the separation. Answer item b. ONLY if you are NOT a parent of the children . b. ___ The Petitioner performs the caretaking and parenting functions for the children. For this reason, the Petitioner believes it is appropriate for the Petitioner to have the authority for making significant decisions relating to the children's care and upbringing. The Petitioner also believes custodial responsibility for the children should be allocated to the Petitioner alone. Answer item c. ONLY if you are a parent of the children . c. The other parent has: ___ abused, neglected, or abandoned one or more of the children; ___ sexually assaulted or abused one or more of the children; ___ engaged in acts of domestic violence; ___ repeatedly interfered with Petitioner's access to, or contact with one or more of the children; ___ repeatedly made false reports or accusations of domestic violence or child abuse; ___ . For these reasons, the Petitioner believes: ___ It is in the children's best interest that the authority for making significant decisions relating to the children's care and upbringing be allocated to the Petitioner alone. ___ The court should impose limits on the other parent's custody of, and contact with the children. ___ The other parent should not be allocated any custodial responsibility, or permitted any contact with the children unless the court specifically finds such custodial responsibility or contact will not endanger the children, or the Petitioner. Answer item d. ONLY if you are NOT a parent of the children . d. The Mother has: ___ abused, neglected, or abandoned one or more of the children; ___ sexually assaulted or abused one or more of the children; ___ engaged in acts of domestic violence; ___ failed to support one or more of the children For these reasons, the Petitioner believes: ___ It is in the children's best interest that the authority for making significant decisions relating to the children's care and upbringing be allocated to the Petitioner alone. ___ The court should impose limits on the Mother's custody of, and
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contact with the children. ___ The Mother should not be allocated any custodial responsibility or permitted any contact with the children unless the court specifically finds such custodial responsibility or contact will not endanger the children, or the Petitioner. Answer item e. ONLY if you, the Petitioner, are NOT a parent of the children . e. The Father has: ___ abused, neglected, or abandoned one or more of the children; ___ sexually assaulted or abused one or more of the children; ___ engaged in acts of domestic violence; ___ failed to support one or more of the children . For these reasons, the Petitioner believes: ___ It is in the children's best interest that the authority for making significant decisions relating to the children's care and upbringing be allocated to the Petitioner alone. ___ The court should impose limits on the Father's custody of, and contact with the children. ___ The Father should not be allocated any custodial responsibility, or permitted any contact with the children unless the court specifically finds such custodial responsibility or contact will not endanger the children, or the Petitioner.

7. THEREFORE, based on the facts set out in this petition, the Petitioner requests the Court to
grant whatever relief the Court deems appropriate, and to grant the following particular relief: a. ___ Order ____________________________________________________ to pay a reasonable amount of money for the support of the children. b. ___ Prohibit __________________________________________________ from threatening, harassing, annoying, or abusing the Petitioner or the children, or in any way interfering with the Petitioner's or children's personal safety. c. ___ Order ___________________________________________________ to maintain health insurance for the children, and to assist with the children's health care expenses that are not covered by insurance or by a government medical card. __________________________ 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.

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___________________________ Signature

____________ Date

This Verification was sworn to or affirmed before me on the ____ day of __________________, 20____.

_________________________
Notary Public / Other official My commission expires:______________________.

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