Person Filing Motion: Name: ____________________________________________ Daytime Telephone No.___________________ Mailing Address: ______________________________________________________________________________ Attorney for ____________________________ Not represented by an attorney Type Or Hand Print Neatly, Using Black Ink Only List names of parties and case number as shown on other documents in this case. IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT ANCHORAGE ) ) ) ) ) ) ) ) CASE NO. ) ) MOTION FOR VISITATION FACILITATION 1. I ask the court to enter an order requiring visitation facilitation through the Anchorage Visitation Facilitation Program. I understand that fees will be charged for these visitation services as explained in the project description (form DR-850 ANCH). 2. CHILDREN List the names of all children for whom visitation facilitation is requested. Child’s Name Date of Birth Who is Child Living With? [Attach extra pages for any additional children.] Is there a current court order for custody and visitation? If yes, please attach a copy. Yes No The court order grants primary shared physical custody of all the children listed above to: ___________________________________________________________ Page 1 of 3 DR-855 ANCH (2/02)(cs) MOTION FOR VISITATION FACILITATION Civil Rules 5(g), 6 and 77 American LegalNet, Inc. www.USCourtForms.com 3. SERVICES REQUESTED What services are you requesting? (Check all that apply.) Coordination of Visitation (agency communicates with the parents in order to arrange the details of visitation). Supervised Visitation (agency will have a facilitator present with the visiting parent and child(ren) during the visitation). Whose visits are to be supervised? Mother’s Father’s Where should visits occur? In visitation facility only May be elsewhere in community Neutral Drop-Off and Pick-Up at the Visitation Facility. Reports to Court Documenting Whether Visits Occurred. One report at end of services Monthly reports Explain in detail why you are requesting these services. [Attach extra pages if necessary.] Page 2 of 3 DR-855 ANCH (2/02)(cs) MOTION FOR VISITATION FACILITATION Civil Rules 5(g), 6 and 77 American LegalNet, Inc. www.USCourtForms.com I certify that all statements in this motion and any attachments are true to the best of my knowledge and belief. Date Signature of Person Filing Motion Notice to Opposing Party You have the right to file a written response to this motion. A form for this (DR-860 ANCH) is available at the court. Your response must state whether you agree to visitation facilitation services or do not agree. If you do not agree, describe why you believe visitation facilitation services are not appropriate. Include the case number in your response. File your response at: 825 West 4th Avenue, Anchorage, AK 99501. You must also mail a copy to the person who filed the motion. Your response must be filed and mailed to the other party within 10 days if the motion was personally served on you or within 13 days (from the date of mailing) if the motion was mailed to you. If you fail to file a response, the court may grant the request for visitation facilitation. CERTIFICATE OF SERVICE [If the opposing party is represented by an attorney, or has been represented within the past year, you must serve the motion on the attorney rather than on the opposing party.] I certify that I mailed (by first class mail) or hand-delivered a copy of this motion to: Name of Other Party or Attorney:____________________________________________ Address:________________________________________________________________ mailed hand-delivered Date:____________________________________ __________________________________________ Signature of Person Filing Motion Page 3 of 3 DR-855 ANCH (2/02)(cs) MOTION FOR VISITATION FACILITATION Civil Rules 5(g), 6 and 77 American LegalNet, Inc. www.USCourtForms.com