IN THE FAMILY COURT OF __________________ COUNTY, WEST VIRGINIA In Re: The Marriage / Children of: ___________________________, Petitioner Civil Action No. _______________ and ___________________________. Respondent ___________________________ ___________________________ Address ___________________________ ___________________________ Address ___________________________ Daytime phone ___________________________ Daytime phone MOTION FOR TEMPORARY RELIEF This Motion is being made by: __________________________________________. (Print your name here.) Yes Yes No No Have you previously requested temporary relief in this case. Has the other party previously requested temporary relief in this case. NOTICE OF MOTION TO: __________________________________________ (Print the name of the opposing party.) TAKE NOTICE that _____________________________________, will come before the (Print your name.) Family Court of ____________________________ County, and make a MOTION for the Court to ORDER certain Temporary Relief. This Motion for Temporary Relief will be made at ________ (time) a.m./ p.m. on the ________ day of ____________________, 20_____. (date) (month) (year) MOTION I, __________________________________________, request the Court to Order the (Print your name here.) Following Temporary Relief. (Check the box in front of the relief you want.) Yes Yes Yes No 1. Determine custodial responsibility and time to be spent with children. No 2. Adopt my Individual Proposed Parenting Plan. (Check "Yes" only if you have attached a Parenting Plan.) No 3. Order a reasonable amount of child support. SCA-FC-112 Rev. 06/2005(F) Motion for Temporary Relief Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Yes Yes Yes Yes Yes Yes Yes No 4. Order a reasonable amount of spousal support (alimony). No 5. Order that health insurance be maintained or established. No 6. Decide the use and/or possession of property. No 7. Determine responsibility for debts and attorney's fees. No 8. Appoint a guardian ad litem for a party or a child of the parties. No 9. Issue a Protective Order. No 10. Other: _____________________________________________________ ____________________________________________________________ ____________________________________________________________ _____________________________________________ (Sign your name before a Notary or Deputy Circuit Clerk.) Sworn to before me on the ______ day of __________________________, 20______. Notary Public / Other Official Commission expires:______________________. CERTIFICATE OF SERVICE State of West Virginia County of _______________________________ I, ________________________________, the person making this Motion for Temporary (Print your name here.) Relief, mailed the Motion and Notice, together with any and all attached documents, by first class United States Mail, postage paid, to ______________________________, at the address of (opposing party) _____________________________________________________________________________, (opposing party's address) on the _______ day of _______________________, 20_______. (date) (month) (year) Signature SCA-FC-112 Rev. 06/2005(F) Motion for Temporary Relief Date Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com