Form 351 (Rev. 10/11) The Family Court of the State of Delaware In and For New Castle Kent Sussex County PETITION TO MODIFY VISITATION Petitioner Name Street Address P.O. Box Number City/State/Zip Code Attorney Name Interpreter needed? Language Yes No D.O.B Respondent Name Street Address P.O. Box Number City/State/Zip Code Attorney Name Interpreter needed? Language Yes No Petition Number D.O.B. File Number 2nd Petitioner (if any) Name Street Address P.O. Box Number City/State/Zip Code Attorney Name Interpreter needed? Language Name 2nd Respondent (if any) D.O.B Name Street Address P.O. Box Number City/State/Zip Code Attorney Name D.O.B. Yes No Interpreter needed? Language Date of Birth Name Yes No IN THE INTEREST OF the following child(ren): Date of Birth Name Date of Birth Name Date of Birth Name Date of Birth Name Date of Birth The said child(ren) live with (Name): Relationship to child(ren): (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Form 351 (Rev. 10/11) Petitioner requests the Court enter an order modifying a prior visitation order of this Court issued by , dated (Judicial Officer) (MM/DD/YY) , and in support there of alleges the following circumstances. (Please list in consecutively numbered paragraphs): Petitioner requests that Visitation be as follows: WHEREFORE, Petitioner prays that a Summons issue to Respondent and that the Court grant relief prayed for or such other relief as may be just. SWORN TO AND SUBSCRIBED before me this date, Petitioner/Attorney Clerk of Court/Notary Public American LegalNet, Inc. www.FormsWorkFlow.com 2 of 2