representing myself, state that: - PDF document

representing myself, state that: name of child date of birthname of child date of birth name of child date of birthname of child date of birth granting custody of the child(ren) to the child(ren) because: Page 2 of 2 Revised 10/2015 4.I know of the following additional cases concerning the child(ren) (such as domestic violence(protective order), paternity, divorce of the child(ren)’s parents, custody, visitation, or Cour Case No. Kind of Case Year Filed Results or Status (if you know) FOR THESE REASONS, I request the Court change custody and/or visitation as follows: S you a and order any othr appropriate relief. [ ] I am also requesting a chang in the current child support order. oingtrue to the best of my knowledge, information, and belief. DateSignature Page 1 of 2 Revised 10/2015 Circuit Court for Case No. City or County Name Name VS. Street Address Apt. #Street AddressApt. # ( ) City State Zip Code Area TelephoneCity State Zip Code Area Telephone Code Code Name Street Address Apt. # City State Zip Code Area Telephone Code PETITION/MOTION TO MODIFY VISITATION I, , representing myself, state that: My name 1. I am Relationship (for example, aunt, grandfather, guardian, etc) name of child date of birthname of child date of birth name of child date of birthname of child date of birth name of child date of birthname of child date of birth name of child date of birthname of child date of birth 2.On the Circuit Court for issued City or County an order in case number , granting custody of the child(ren) to and visitation to . the child(ren) because: