SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT Domestic Relations Branch _________________________________ PRINT PLAINTIFF’S NAME PLAINTIFF, v. _________________________________ _______DRB ___________ RELATED CASES: _____________________________ _____________________________ PRINT DEFENDANT’S NAME DEFENDANT. MOTION TO MODIFY VISITATION Does the Other Party Consent to this Motion? I, _________________________________, am the PRINT YOUR NAME PLAINTIFF DEFENDANT CUSTODY yes no in this case. 1. A custody order and/or visitation order was previously entered in this case on _____________________________________. DATE OF ORDER 2. This Court is the proper place to decide this Motion because this Court entered the original custody and/or visitation order, AND: [CHECK ALL THAT APPLY] The child(ren) still live(s) in the District of Columbia. At least one parent or person acting as a parent still lives in the District of Columbia. The child(ren) has/have a significant connection to the District of Columbia and there is sufficient information about the child(ren) available in the District. DC Bar Pro Bono Program (revised 1.2011 ) Motion to Modify Visitation and/or Custody Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com 3. There has been a substantial and material change in circumstances since the time the existing order was established. The change in circumstances is: [CHECK ONE] The child(ren) now live(s) with me. The child(ren) no longer live(s) with me. Other: [DESCRIBE THE CHANGE] 4. Because of the substantial and material change in circumstances, the existing order should be changed. The new order should say: [DESCRIBE THE CHANGE YOU ARE REQUESTING] 5. The modification I am requesting is in the child(ren)’s best interests because: [EXPLAIN WHY THE CHANGE YOU ARE REQUESTING IS BEST FOR THE CHILD(REN)] Request for Relief I RESPECTFULLY REQUEST that the Court: [CHECK ALL THAT APPLY] Grant my request to modify visitation and/or custody. Enter an Order setting forth a revised visitation schedule and/or custodial arrangement that is in the best interests of the minor child(ren). DC Bar Pro Bono Program (revised 1.2011) Motion to Modify Visitation and/or Custody Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com I ALSO REQUEST that the Court award any other relief it considers fair and proper. I DO DO NOT request an oral hearing in front of the judge on this motion. I solemnly swear or affirm under criminal penalties for the making of a false statement that I have read the foregoing Motion to Modify Visitation and/or Custody and that the factual statements made in it are true to the best of my personal knowledge, information and belief. Respectfully Submitted, ____________________________________ SIGN YOUR NAME ____________________________________ STREET ADDRESS ____________________________________ CITY, STATE AND ZIP CODE ____________________________________ TELEPHONE NUMBER SUBSTITUTE ADDRESS: CHECK BOX IF YOU HAVE WRITTEN SOMEONE ELSE’S ADDRESS BECAUSE YOU FEAR HARASSMENT OR HARM. If by consent: ___________________________________ ______________________________ OTHER PARTY’S SIGNATURE DATE DC Bar Pro Bono Program (revised 1.2011) Motion to Modify Visitation and/or Custody Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com POINTS AND AUTHORITIES IN SUPPORT OF MOTION TO MODIFY CUSTODY OR VISTATION In support of this Motion, I refer to: 1. D.C. SCR-Dom. Rel.R. 7(b) (2009). 2. D.C. Code §§16-914, 16-914.01 and 16-4602.02 (2009). 3. The record in this case. 4. The attached supporting document(s), if any. [LIST ANY DOCUMENTS THAT YOU ARE ATTACHING] __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ _________________________________________________________________. DC Bar Pro Bono Program (revised 1.2011) Motion to Modify Visitation and/or Custody Page 4 of 5 American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT Domestic Relations Branch _________________________________ PRINT PLAINTIFF’S NAME _______DRB ___________ PLAINTIFF, v. _________________________________ PRINT DEFENDANT’S NAME DEFENDANT. RULE 5 CERTIFICATE OF SERVICE I certify that I served a copy of my Motion to Modify Visitation and/or Custody to the other party or the other party’s attorney on _________________________. DATE OF SERVICE The papers were delivered: [CHECK ONE] by handing them to the other party. by first class mail: by fax: by leaving a copy at the other party’s workplace with a clerk or person in charge, or because there was no one in charge, by leaving it in a conspicuous place: by leaving a copy at the other party’s home with a person of suitable age and discretion who lives there: _____________________________________________________________ PRINT NAME OF PERSON SERVED WITH PAPERS _____________________________________________________________ STREET ADDRESS/FAX # CITY, STATE AND ZIP CODE _____________________________ _____________________________ SIGN YOUR NAME DATE DC Bar Pro Bono Program (revised 1.2011) Motion to Modify Visitation and/or Custody Page 5 of 5 American LegalNet, Inc. www.FormsWorkFlow.com