Free Petition for Modification - West Virginia

IN THE FAMILY COURT OF ________________ COUNTY, WEST VIRGINIA.
In Re: The Marriage / Children of: _________________________, Petitioner _________________________ _________________________
Address

Civil Action No. ____________ and _________________________. Respondent _________________________ _________________________
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
Petition for Modification Page 1 of 3

SCA-FC-201 (12/01)

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

___________________________ 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