Form 172 (Rev 08/11) The Family Court of the State of Delaware In and For New Castle Kent Sussex County PETITION FOR THIRD-PARTY VISITATION Petitioner Name Street Address P.O. Box Number City/State/Zip Code Home Phone Number Relation to Child(ren) Work Phone Number D.O.B. Respondent Name Street Address P.O. Box Number City/State/Zip Code Home Phone Number Relation to Child(ren) Work Phone Number D.O.B. File Number Petition Number 2nd Petitioner (if any) Name Street Address P.O. Box Number City/State/Zip Code Home Phone Number Work Phone Number D.O.B. 2nd Respondent (if any) Name Street Address P.O. Box Number City/State/Zip Code Home Phone Number Work Phone Number D.O.B. Relation to Children Relation to Children IN THE INTEREST OF THE FOLLOWING CHILD(REN): (Complete the table below for each child with whom visitation is sought. Attach additional sheets if necessary.) Child's Name Child's Date of Birth Child's Place of Birth (City, State) Child's Gender (Check one) Male Female Male Female Male Female 1. Complete the table below regarding the child(ren)'s parents (individuals holding parental rights): NAME Address Date of Birth MOTHER FATHER 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Form 172 (Rev 08/11) 2. If you do not know the name/address of the child(ren)'s mother and/or father, write in the space provided below what you have done to try to locate him/her/them. Attached to this Petition is the following affidavit in support of my answer to section 2: Affidavit that a Party's Address is Unknown 3. I am eligible for visitation because: I have a substantial and positive relationship with the child; AND/OR I am a grandparent, aunt, uncle or adult sibling of the child I am a Guardian ad litem petitioning on behalf of a child against the child's parent. Guardian and/or DSCYF and the adult person with whom visitation is sought consents to visitation with the child and has a substantial and positive prior relationship with the child or is a grandparent, aunt, uncle or adult sibling of the child. I am a Guardian ad litem petitioning on behalf of a child seeking visitation with another child with whom they have at least one parent in common. 4. Complete this section only if you are a parent or relative of a parent whose parental rights have been terminated. I am a parent or relative of a parent whose parental rights have been terminated and: More than 3 years have passed since the termination of parental rights order was entered and the child has not been adopted; or The adoptive parents previously entered into a written notarized agreement or court approved agreement for continued visitation A copy of the agreement is attached to this petition. 5. In support of my petition I allege the following: Third party visitation is in the best interest of the child(ren). At least one of the following is true as to each parent: Mother The parents consent to the visitation The child is dependant, neglected or abused in the parent's care The parent is deceased The parent objects to the visitation Father 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Form 172 (Rev 08/11) 6. If the parent objects to the visitation: I allege that the objection is unreasonable and the visitation will not substantially interfere with the parent/child relationship. VERIFICATION STATE OF DELAWARE COUNTY OF ) ) ss.: ) _______________________________________, being duly sworn, says: I am the Petitioner in this action. I have read the above Petition and know to the best of my knowledge that the facts contained therein are true. Petitioner 1 Subscribed and sworn before me on this date, Petitioner 2 Date Notary Public 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com